Combining glucose and high-sensitivity cardiac troponin in the early diagnosis of acute myocardial infarction.

Humans Non-ST Elevated Myocardial Infarction Myocardial Infarction Early Diagnosis Glucose Troponin

Journal

Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288

Informations de publication

Date de publication:
05 09 2023
Historique:
received: 15 03 2023
accepted: 15 06 2023
medline: 7 9 2023
pubmed: 6 9 2023
entrez: 5 9 2023
Statut: epublish

Résumé

Glucose is a universally available inexpensive biomarker, which is increased as part of the physiological stress response to acute myocardial infarction (AMI) and may therefore help in its early diagnosis. To test this hypothesis, glucose, high-sensitivity cardiac troponin (hs-cTn) T, and hs-cTnI were measured in consecutive patients presenting with acute chest discomfort to the emergency department (ED) and enrolled in a large international diagnostic study (NCT00470587). Two independent cardiologists centrally adjudicated the final diagnosis using all clinical data, including serial hs-cTnT measurements, cardiac imaging and clinical follow-up. The primary diagnostic endpoint was index non-ST-segment elevation MI (NSTEMI). Prognostic endpoints were all-cause death, and cardiovascular (CV) death or future AMI, all within 730-days. Among 5639 eligible patients, NSTEMI was the adjudicated final diagnosis in 1051 (18.6%) patients. Diagnostic accuracy quantified using the area under the receiver-operating characteristics curve (AUC) for the combination of glucose with hs-cTnT and glucose with hs-cTnI was very high, but not higher versus that of hs-cTn alone (glucose/hs-cTnT 0.930 [95% CI 0.922-0.937] versus hs-cTnT 0.929 [95% CI 0.922-0.937]; glucose/hs-cTnI 0.944 [95% CI 0.937-0.951] versus hs-cTnI 0.944 [95% CI 0.937-0.951]). In early-presenters, a dual-marker strategy (glucose < 7 mmol/L and hs-cTnT < 5/hs-cTnI < 4 ng/L) provided very high and comparable sensitivity to slightly lower hs-cTn concentrations (cTnT/I < 4/3 ng/L) alone, and possibly even higher efficacy. Glucose was an independent predictor of 730-days endpoints. Our results showed that a dual marker strategy of glucose and hs-cTn did not increase the diagnostic accuracy when used continuously. However, a cutoff approach combining glucose and hs-cTn may provide diagnostic utility for patients presenting ≤ 3 h after onset of symptoms, also providing important prognostic information.

Identifiants

DOI: 10.1038/s41598-023-37093-1 PMID: 37670005 PMC: PMC10480296
pubmed: 37670005
doi: 10.1038/s41598-023-37093-1
pii: 10.1038/s41598-023-37093-1
pmc: PMC10480296
doi:

Substances chimiques

teloxantrone 96521WL61B
Glucose IY9XDZ35W2
Troponin 0

Banques de données

ClinicalTrials.gov
['NCT00470587']

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

14598

Informations de copyright

© 2023. Springer Nature Limited.

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Auteurs

Ana Yufera-Sanchez (A)

Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
GREAT Network, Basel, Switzerland.

Pedro Lopez-Ayala (P)

Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
GREAT Network, Basel, Switzerland.

Thomas Nestelberger (T)

Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
GREAT Network, Basel, Switzerland.

Karin Wildi (K)

Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
GREAT Network, Basel, Switzerland.
Department of Intensive Care, University Hospital Basel, University of Basel, Basel, Switzerland.

Jasper Boeddinghaus (J)

Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
GREAT Network, Basel, Switzerland.
Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK.

Luca Koechlin (L)

Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
GREAT Network, Basel, Switzerland.
Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.

Maria Rubini Gimenez (M)

Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
Cardiology Department, Heart Center Leipzig, Leipzig, Germany.

Hüseyin Sakiz (H)

Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
GREAT Network, Basel, Switzerland.

Paolo Bima (P)

Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
GREAT Network, Basel, Switzerland.
Department of Medical Sciences, University of Turin, Turin, Italy.

Oscar Miro (O)

GREAT Network, Basel, Switzerland.
Emergency Department, Hospital Clinic, Barcelona, Catalonia, Spain.

F Javier Martín-Sánchez (FJ)

GREAT Network, Basel, Switzerland.
Emergency Department, Hospital Clínico San Carlos, Madrid, Spain.

Michael Christ (M)

Department of Emergency Medicine, Luzerner Kantonsspital, Luzern, Switzerland.

Dagmar I Keller (DI)

Emergency Department, University Hospital Zurich, Zurich, Switzerland.

Danielle M Gualandro (DM)

Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
GREAT Network, Basel, Switzerland.

Damian Kawecki (D)

2nd Department of Cardiology, School of Medicine in Zabrze, Medical University of Sielsia, Katowice, Poland.

Katharina Rentsch (K)

Laboratory Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.

Andreas Buser (A)

Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland.
Department of Hematology, University Hospital Basel, University of Basel, Basel, Switzerland.

Christian Mueller (C)

Department of Cardiology, University Heart Center Basel, and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland. christian.mueller@usb.ch.
GREAT Network, Basel, Switzerland. christian.mueller@usb.ch.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Combining glucose and high-sensitivity cardiac...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Nécrose › Infarctus › Infarctus du myocarde › Infarctus du myocarde sans sus-décalage du segment ST › Combining glucose and high-sensitivity cardiac...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Nécrose › Infarctus › Infarctus du myocarde › Combining glucose and high-sensitivity cardiac...
questionsmedicales.fr › Diagnostic › Diagnostic précoce › Combining glucose and high-sensitivity cardiac...
questionsmedicales.fr › Glucides › Sucres › Oses › Hexose › Glucose › Combining glucose and high-sensitivity cardiac...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Protéines du cytosquelette › Protéines des microfilaments › Troponine › Combining glucose and high-sensitivity cardiac...