Short Cardiac Biomarker Protocols May Underestimate Heart Damage

MedicalResearch.com Interview with:
Anne Vorlat MD

Department of Cardiology
Antwerp University Hospital
Department of Cardiology, Edegem, Belgium

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Vorlat: Early diagnosis of myocardial infarction is critical for optimal treatment and prognosis of the patient. The third universal definition of myocardial infarction states that a rise and/or fall of cardiac biomarkers (preferably troponin) with at least one value above the 99th percentile of the upper reference limit is mandatory with symptoms and or ST segment changes on the ECG. Since the development of more sensitive assays for cardiac troponins, myocardial injury can be detected earlier. This has permitted to shorten the timing of the second sampling of cardiac biomarkers from 6h to 3h after the first sampling. Recent studies have tested biomarker protocols with a very short delay (e.g., 1 hour) or with a single measurement of troponin and copeptin (a marker of endogenous stress, not cardiac specific) to rule in or to rule out myocardial injury in a population with chest pain. Although these newer protocols appear to be promising, early presenters (chest pain for less than 2 hours) are underreported. The present study evaluated the usefulness of early rule-in and rule-out biomarker protocols to estimate ischemia-induced myocardial injury in an early presenter model. The “early presenter” model was tested in 107 stable patients after a short period of myocardial ischemia, induced by stenting of a significant coronary artery stenosis. High-sensitivity troponin T (hsTnT), hsTnI and copeptin were measured at the start, and 90, 180 and 360 minutes after stent implantation. We confirmed our hypothesis that short biomarkers protocols underestimate myonecrosis in early presenters.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Vorlat: The ongoing efforts to minimize the delay between diagnosis and treatment of acute coronary syndromes encourages fast track protocols. The use of point of care assays in the emergency department and the pre-hospital setting, to minimize the delay between diagnosis and treatment of acute coronary syndromes will increase. Moreover, the ongoing efforts to improve the awareness of the general public for acute coronary syndromes, the early presenters will increase at the emergency departments. Therefore a better knowledge about the diagnostic accuracy of troponin assays and fast track biomarker protocols for detecting ischemia induced myocardial injury in early presenters is crucial . We confirmed our hypothesis that short biomarkers protocols underestimate myonecrosis in early presenters. At present, the best approach for the diagnosis of myocardial injury in early presenters is a standard assessment of high-sensitivity troponin after 3 hours.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Vorlat: For future research, the study of the slope of troponin rise over shorter time intervals (e.g. between 30 and 60 min) could be of interest for recognizing early myocardial injury in early presenters. Moreover, the search for even more specific markers with an earlier release/detection is ongoing.

Citation:

Usefulness of Early Rule-in and Rule-out Biomarker Protocols to Estimate Ischemia-induced Myocardial Injury in Early Chest Pain Presenters

Anne Vorlat, MD ,Viviane O. Van Hoof, MD, PhD, Rania Hammami, MD, Stephanie van Kerckhoven, MD,Catharina M. Van der Heijden, MD, Dries Coenen, MSPharm, Johan M. Bosmans, MD, PhD, Steven Haine, MD, PhD Tom R. Vandendriessche, MD MD Christiaan J. Vrints, PhD Marc J. Claeys, MD, PhD
The American Journal of Cardiology

Available online 23 March 2015

Received 14 January 2015, Revised 25 February 2015, Accepted 1 March 2015,
Available online 23 March 2015

 

MedicalResearch.com Interview with:, & Anne Vorlat MD (2015). Short Cardiac Biomarker Protocols May Underestimate Heart Damage MedicalResearch.com