Biomarkers After Risk Stratification in Acute Chest Pain (from the BRIC Study)

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• 作者：Shiny Mathewkutty ; MD^a ; ^&dagger ; ; Sanjum S. Sethi ; MD^a ; ^&dagger ; ; Ashish Aneja ; MD^d ; Kshitij Shah ; MD^e ; Rupa L. Iyengar ; MPH^a ; Luke Hermann ; MD^b ; Sayyar Khakimov ; BA^a ; Louai Razzouk ; MD^f ; Ricardo Esquitin ; MD^g ; Rajesh Vedanthan ; MD ; MPH^a ; Terrie-Ann Benjamin ; MD ; MHS^h ; Marie Grace ; PhD^c ; Rosane Nisenbaum ; PhDⁱ ; Krishnan Ramanathan ; MD^j ; Lakshmi Ramanathan ; PhD^c ; James Chesebro ; MD^k ; Michael E. Farkouh ; MD ; MSc^a ; ^l ; ^{michael.farkouh@mssm.edu}
• 刊名：The American Journal of Cardiology
• 出版年：2013
• 出版时间：15 February, 2013
• 年：2013
• 卷：111
• 期：4
• 页码：493-498
• 全文大小：126 K

文摘

Current models incompletely risk-stratify patients with acute chest pain. In this study, N-terminal pro-B-type natriuretic peptide and cystatin C were incorporated into a contemporary chest pain triage algorithm in a clinically stratified population to improve acute coronary syndrome discrimination. Adult patients with chest pain presenting without myocardial infarction (n?= 382) were prospectively enrolled from 2008 to 2009. After clinical risk stratification, N-terminal pro-B-type natriuretic peptide and cystatin C were measured and standard care was performed. The primary end point was the result of a clinical stress test. The secondary end point was any major adverse cardiac event at 6 months. Associations were determined through multivariate stratified analyses. In the low-risk group, 76 of 78 patients with normal levels of the 2?biomarkers had normal stress test results (negative predictive value 97 % ). Normal biomarkers predicted normal stress test results with an odds ratio of 10.56 (p?=?0.006). In contrast, 26 of 33 intermediate-risk patients with normal levels of the 2 biomarkers had normal stress test results (negative predictive value 79 % ). Biomarkers and stress test results were not associated in the intermediate-risk group (odds ratio 2.48, p?= 0.09). There were 42 major adverse cardiac events in the overall cohort. No major adverse cardiac events occurred at 6 months in the low-risk subgroup that underwent stress testing. In conclusion, N-terminal pro-B-type natriuretic peptide and cystatin C levels predict the results of stress tests in low-risk patients with chest pain but should not be substituted for stress testing in intermediate-risk patients. There is potential for their use in the early discharge of low-risk patients after clinical risk stratification.