Multi-Marker Approach in Patients with Acute Chest Pain in the Emergency Department
-
Published:2024-05-25
Issue:6
Volume:14
Page:564
-
ISSN:2075-4426
-
Container-title:Journal of Personalized Medicine
-
language:en
-
Short-container-title:JPM
Author:
Piccioni Andrea1ORCID, Baroni Silvia2ORCID, Manca Federica1, Sarlo Francesca2, Savioli Gabriele3, Candelli Marcello1ORCID, Bronzino Alessandra1, Covino Marcello1ORCID, Gasbarrini Antonio4ORCID, Franceschi Francesco1
Affiliation:
1. Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168 Roma, Italy 2. Unit of Chemistry, Biochemistry and Clinical Molecular Biology, Department of Laboratory and Hematological Sciences, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy 3. Departement of Emergency, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy 4. Medical and Surgical Science Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
Abstract
Background: Chest pain is a prevalent reason for emergency room referrals and presents diagnostic challenges. The physician must carefully differentiate between cardiac and noncardiac causes, including various vascular and extracardiovascular conditions. However, it is crucial not to overlook serious conditions such as acute coronary syndrome (ACS). Diagnosis of acute myocardial infarction (AMI) and early discharge management become difficult when traditional clinical criteria, ECG, and troponin values are insufficient. Recently, the focus has shifted to a “multi-marker” approach to improve diagnostic accuracy and prognosis in patients with chest pain. Methods: This observational, prospective, single-center study involved, with informed consent, 360 patients presenting to the emergency department with typical chest pain and included a control group of 120 healthy subjects. In addition to routine examinations, including tests for hsTnI (Siemens TNIH kit), according to the 0–1 h algorithm, biochemical markers sST2 (tumorigenicity suppression-2) and suPAR (soluble urokinase plasminogen activator receptor) were also evaluated for each patient. A 12-month follow-up was conducted to monitor outcomes and adverse events. Results: We identified two groups of patients: a positive one (112 patients) with high levels of hsTnI, sST2 > 24.19 ng/mL, and suPAR > 2.9 ng/mL, diagnosed with ACS; and a negative one (136 patients) with low levels of hsTnI, suPAR < 2.9 ng/mL, and sST2 < 24.19 ng/mL. During the 12-month follow-up, no adverse events were observed in the negative group. In the intermediate group, patients with hsTnI between 6 ng/L and the ischemic limit, sST2 > 29.1 ng/mL and suPAR > 2.9 ng/mL, showed the highest probability of adverse events during follow-up, while those with sST2 < 24.19 ng/mL and suPAR < 2.9 ng/mL had a better outcome with no adverse events at 12 months. Conclusion: Our data suggest that sST2 and suPAR, together with hsTnI, may be useful in the prognosis of cardiovascular patients with ACS, providing additional information on endothelial damage. These biomarkers could guide the clinical decision on further diagnostic investigations. In addition, suPAR and sST2 emerge as promising for event prediction in patients with chest pain. Their integration into the standard approach in PS could facilitate more efficient patient management, allowing safe release or timely admission based on individual risk.
Reference38 articles.
1. McDevitt-Petrovic, O., Kirby, K., and Shevlin, M. (2017). The prevalence of non-cardiac chest pain (NCCP) using emergency department (ED) data: A Northern Ireland based study. BMC Health Serv. Res., 17. 2. National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary;Pitts;Natl. Health Stat. Rep.,2008 3. Noncardiac chest pain;Fass;J. Clin. Gastroenterol.,2008 4. Classification, natural history, epidemiology, and risk factors of noncardiac chest pain;Eslick;Dis. Mon.,2008 5. Diagnosing the cause of chest pain;Cayley;Am. Fam. Physician,2005
|
|