Document Detail

Assessment of the multiple-biomarker approach for diagnosis of myocardial infarction in patients presenting with symptoms suggestive of acute coronary syndrome.
MedLine Citation:
PMID:  19028826     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Cardiac troponin is the preferred biomarker for detecting acute myocardial injury and infarction (MI). We studied whether multiple biomarkers of numerous pathophysiological pathways would increase the diagnostic accuracy for detecting MI. METHODS: Seven biomarkers [myeloperoxidase, soluble CD40 ligand, placental growth factor, matrix metalloproteinase 9 (MMP-9), high-sensitivity C-reactive protein (hsCRP), cardiac troponin I (cTnI), N-terminal pro-B-type natriuretic peptide] and estimated glomerular filtration rate were measured in 457 patients presenting on admission with symptoms suggestive of acute coronary syndrome. Twenty-five patients (5.4%) received MI diagnoses. Clinical sensitivities and specificities were evaluated from 99th-percentile reference values. Forward and backward stepwise logistic regression modeling techniques were used to identify biomarkers that were independently predictive of MI. RESULTS: Biomarker sensitivities ranged from 20% to 96%, and specificities ranged from 19% to 89%. MMP-9 had the highest sensitivity, but its specificity was 19%. cTnI demonstrated a sensitivity of 72% (95% CI, 51%-88%) and a specificity of 89% (95% CI, 85%-92%). In multivariate models, cTnI (P < 0.001) and either hsCRP (P = 0.009) or MMP-9 (P = 0.03) were independently predictive of MI. Addition of hsCRP or MMP-9 increased the specificity to 95% (95% CI, 92%-97%) or 91% (95% CI, 88%-94%), respectively, but reduced the sensitivity to 56% (95% CI, 35%-76%) and 68% (95% CI, 47%-85%) relative to cTnI alone. CONCLUSIONS: Our findings indicate that the most clinically accurate biomarker for the early diagnosis of MI is the use of cTnI alone, rather than a multiple-biomarker approach, when an analytically robust cardiac troponin assay based on the 99th percentile is used.
Fred S Apple; Stephen W Smith; Lesly A Pearce; MaryAnn M Murakami
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-11-21
Journal Detail:
Title:  Clinical chemistry     Volume:  55     ISSN:  1530-8561     ISO Abbreviation:  Clin. Chem.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-24     Completed Date:  2009-01-29     Revised Date:  2009-11-25    
Medline Journal Info:
Nlm Unique ID:  9421549     Medline TA:  Clin Chem     Country:  United States    
Other Details:
Languages:  eng     Pagination:  93-100     Citation Subset:  IM    
Department of Laboratory Medicine, Hennepin County Medical Center, University of Minnesota School of Medicine, Minneapolis, MN, USA.
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MeSH Terms
Acute Coronary Syndrome / blood*,  diagnosis*
Biological Markers / blood*
C-Reactive Protein / analysis
CD40 Ligand / blood
Enzyme-Linked Immunosorbent Assay
Glomerular Filtration Rate
Logistic Models
Matrix Metalloproteinase 9 / blood
Middle Aged
Myocardial Infarction / blood*,  diagnosis*
Natriuretic Peptide, Brain / blood
Peptide Fragments / blood
Peroxidase / blood
Pregnancy Proteins / blood
Risk Assessment
Sensitivity and Specificity
Troponin I / blood
Reg. No./Substance:
0/Biological Markers; 0/Peptide Fragments; 0/Pregnancy Proteins; 0/Troponin I; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; 144589-93-5/placenta growth factor; 147205-72-9/CD40 Ligand; 9007-41-4/C-Reactive Protein; EC; EC Metalloproteinase 9
Comment In:
Clin Chem. 2009 Jan;55(1):9-11   [PMID:  19028816 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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