Investigation of a multi-marker approach to the initial assessment of patients presenting to hospital with acute chest pain

• Main Author: McCann, Conor Joseph
• Published: Queen's University Belfast 2008
• Subjects: 616.1
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.492031

In current medical practice an elevation in the level of the biochemical marker cardiac troponin is used to identify patients with acute chest pain who have an acute myocardial infarction and to predict the risk of recurrent adverse events. This strategy is sub-optimal. In addition, other available early markers of myocyte injury are not specific. The aim of the research presented in this thesis was to assess early detection of myocardial infarction in patients with chest pain using additional biomarkers and to determine their role in the subsequent 1 year follow-up. Patients presenting to 2 coronary care units With. ischaemic type chest pain between August 2003 - July 2006 were recruited prospectively. Patients were assessed on admission for clinical characteristics, ECG features, renal function, cardiac troponin T, inflammatory markers (high sensitivity CRP, myeloperoxidase, matrix metalloproteinase-9, pregnancy associated plasma protein-A, soluble CD40 ligand), haemostatic markers (fibrinogen, D-dimer), myocyte injury markers (heart fatty acid binding protein, glycogen phosphorylase-BB), and the neurohormonal marker NT-proBNP. A 12 hour ~ardiac troponin T sample was also obtained. For diagnosis of acute myocardial infarction, the performance of the additional biomarkers were compared with the initial sample of cardiac troponin T. Patients were followed up for 1 year for the incidence of adverse events. The value of elevated biomarkers for risk stratification was assessed. The sensitivity of heart fatty acid binding protein for acute myocardial infarction was superior to initial cardiac troponin T for patients presenting within 4 hours of symptom onset. Additionally, heart fatty acid binding protein and NTproBNP demonstrated significant independent value for prediction of recurrent adverse events; the other biomarkers assessed did not.