| Assessment of the multiple-biomarker approach for diagnosis of myocardial infarction in patients presenting with symptoms suggestive of acute coronary syndrome. | |
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MedLine Citation:
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PMID: 19028826 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Fred S Apple; Stephen W Smith; Lesly A Pearce; MaryAnn M Murakami |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2008-11-21 |
Journal Detail:
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Title: Clinical chemistry Volume: 55 ISSN: 1530-8561 ISO Abbreviation: Clin. Chem. Publication Date: 2009 Jan |
Date Detail:
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Created Date: 2008-12-24 Completed Date: 2009-01-29 Revised Date: 2009-11-25 |
Medline Journal Info:
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Nlm Unique ID: 9421549 Medline TA: Clin Chem Country: United States |
Other Details:
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Languages: eng Pagination: 93-100 Citation Subset: IM |
Affiliation:
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Department of Laboratory Medicine, Hennepin County Medical Center, University of Minnesota School of Medicine, Minneapolis, MN, USA. apple004@umn.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Coronary Syndrome
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blood*,
diagnosis* Aged Biological Markers / blood* C-Reactive Protein / analysis CD40 Ligand / blood Enzyme-Linked Immunosorbent Assay Female Glomerular Filtration Rate Humans Logistic Models Male 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 Solubility Troponin I / blood |
| Chemical | |
Reg. No./Substance:
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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 1.11.1.7/Peroxidase; EC 3.4.24.35/Matrix Metalloproteinase 9 |
| Comments/Corrections | |
Comment In:
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Clin Chem. 2009 Jan;55(1):9-11
[PMID:
19028816
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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