Multiple Cardiac Biomarkers Used in Clinical Guideline for Elderly Patients with Acute Coronary Syndrome
| Autor: | Weide Tsai, Shou-Chuan Shih, Wen-Han Chang, Ding-Kuo Chien, Chien-Hsuan Huang |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Acute coronary syndrome Point-of-care testing 030204 cardiovascular system & hematology lcsh:Geriatrics Chest pain Likelihood ratios in diagnostic testing elderly acute coronary syndrome 03 medical and health sciences 0302 clinical medicine Internal medicine medicine 030212 general & internal medicine Intensive care medicine Receiver operating characteristic business.industry biomarkers Emergency department Guideline medicine.disease point of care lcsh:RC952-954.6 Biomarker (medicine) Geriatrics and Gerontology medicine.symptom business |
| Zdroj: | International Journal of Gerontology, Vol 11, Iss 2, Pp 104-108 (2017) |
| ISSN: | 1873-9598 |
| Popis: | Summary Background Bedside cardiac biomarker (CB) is a crucial diagnostic tool used in the emergency department (ED) for older patients with chest pain. We compared various bedside CB panels test results and suggested a bedside-testing-based clinical guideline with improved accuracy of diagnosis and more time efficiency for this group of patients. Methods 146 elderly patients (age ≥ 65) received three different bedside CB panel tests. One test had multiple cardiac biomarkers (MCB) including myoglobin, Troponin-I, creatinine kinase myocardial band isoenzyme (CK-MB), B-natriuretic peptide (BNP); another one had two biomarkers Troponin-I and CK-MB; the last one tested with Troponin-I only. The final clinical diagnosis of each patient had confirmed in 45 days afterward. We evaluated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR−), and receiver operating characteristic (ROC) curve. Results The sensitivity of the bedside MCB system was 80%, and the NPV was 87%, which proved to be of more benefit than the other two CB panel tests (0.14, 0.23 vs. 0.79, 0.79). In contrast, the CB test based on Troponin-I alone had the best LR+, as opposed to the CB test of Troponin-I with CK-MB, and the MCB test (15.86 vs. 4.23, 1.43). Conclusion Bedside MCB test system with high levels of sensitivity and NPV can be a preferred point of care test used in our suggested guideline to help ER physicians rapidly differentiate elderly patients with ACS from ones with non-cardiac chest pain. |
| Databáze: | OpenAIRE |
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