title: The feasibility and diagnostic accuracy by multiple cardiac biomarkers in emergency chest pain patients: a clinical analysis to compare 290 suspected acute coronary syndrome cases stratified by age and gender in Taiwan.
abstract: Accurate diagnosis of acute coronary syndrome (ACS) in a timely fashion is challenging in the elderly population, especially elderly women, who usually exhibit atypical clinical symptoms. A multiple cardiac biomarker (MCB) based approach has been shown to improve diagnostic efficacy of ACS. However, data in various age groups and sex differences remain largely unexplored.
  
  
  
  Point-of-care testing (POCT) was performed on 290 patients (aged ≥18 years) who were admitted to the emergency department (ED) with symptoms of acute chest pain under suspicion of acute coronary syndrome (ACS). The MCB approach in current work assessed four cardiac biomarkers: myoglobin, troponin I, creatine kinase-myocardial band isoenzyme fraction (CK-MB), and brain natriuretic peptide (BNP).
  
  
  
  Overall, the MCB approach demonstrated considerably higher sensitivity for elderly patients than for younger patients in identifying ACS (80.0 % [64.1-90.0] vs. 52.6 % [37.3-67.5] for ≥65 years and <65 years groups), with younger population showed greater specificity (44.1 % [35.3-53.4] vs. 84.9 % [76.9-90.5] for ≥65 years and <65 years groups, respectively). The highest sensitivity achieved for elderly women who reported chest pain was 87.5 % [95 % CI: 64-96.5]). In general, the sensitivity of this approach was higher for female patients than for male patients (80 % [58.4-91.9] vs. 61 % [47.8-73.0]).
  
  
  
  The MCB approach can provide a quick and accurate clinical diagnosis in elderly and female patients, both of whom have traditionally proven to be challenging to diagnose from suspected acute coronary syndrome.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, MacKay Memorial Hospital, Taipei, Taiwan.|Department of Medicine, Mackay Medical College, New Taipei city, Taiwan.
authors.forename: Chung-Lieh
authors.initials: CL
authors.lastname: Hung
authors.affiliation: Emergency Department, MacKay Memorial Hospital, Taipei, Taiwan.|Department of Nursing, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.|Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.|Institute of Mechatronic Engineering, National Taipei University of Technology, Taipei, Taiwan.
authors.forename: Ding-Kuo
authors.initials: DK
authors.lastname: Chien
authors.affiliation: Department of Medicine, Mackay Medical College, New Taipei city, Taiwan.|Department of Nursing, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.|Department of Internal Medicine, Division of Gastroenterology, MacKay Memorial Hospital, Taipei, Taiwan.
authors.forename: Shou-Chuan
authors.initials: SC
authors.lastname: Shih
authors.affiliation: Department of Medicine, Mackay Medical College, New Taipei city, Taiwan. branden888@gmail.com.|Emergency Department, MacKay Memorial Hospital, Taipei, Taiwan. branden888@gmail.com.|Department of Nursing, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan. branden888@gmail.com.|Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan. branden888@gmail.com.|Institute of Mechatronic Engineering, National Taipei University of Technology, Taipei, Taiwan. branden888@gmail.com.|, 92, Section 2, Chungshan North Road, Taipei, Taiwan. branden888@gmail.com.|School of Medicine, Taipei Medical University, Taipei, Taiwan. branden888@gmail.com.
authors.forename: Wen-Han
authors.initials: WH
authors.lastname: Chang
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D052279:Creatine Kinase, MB Form / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012737:Sex Factors; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T; D052279:Creatine Kinase, MB Form
keywords: Acute coronary syndrome; Elderly; Multiple cardiac biomarker