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Combination of clinical risk profile, early exercise testing and circulating biomarkers for evaluation of patients with acute chest pain without ST-segment deviation or troponin elevation.
Heart 2008; 94(3):311-5H

Abstract

OBJECTIVE

To investigate the combination of clinical data, exercise testing and biomarkers for the evaluation of patients with chest pain without ST-segment deviation or troponin elevation.

DESIGN

Prospective cohort design. SETTTING: Two teaching hospitals in Spain.

PATIENTS

422 patients presenting to the emergency department were studied. Leukocyte count, C-reactive protein (CRP), pregnancy-associated plasma protein A (PAPP-A) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were determined. A validated clinical risk score (number of points according to pain characteristics and risk factors) was used for clinical evaluation and early exercise testing was performed.

MAIN OUTCOME MEASURES

Adverse events (death, myocardial infarction or revascularisation) during a median 60 weeks follow-up.

RESULTS

By receiver operating characteristic curve analysis, the association between death or myocardial infarction and adverse events was not significant with leukocyte count (p = 0.3, p = 0.3) or CRP (p = 0.5, p = 0.8), was borderline significant with PAPP-A (p = 0.07, p = 0.04) and strongly significant with NT-pro-BNP (p = 0.0001, p = 0.0001). By Cox regression including clinical risk score, exercise testing result and biomarkers, exercise testing was the independent predictor of revascularisation (p = 0.0001), whereas risk score (p = 0.03) and NT-proBNP (p = 0.0004) predicted death or myocardial infarction. The inclusion of NT-proBNP improved the accuracy of the model for death or myocardial infarction (C-statistic 0.84 versus 0.76, p = 0.01). The combination of clinical score and NT-proBNP afforded the stratification in high (17.2%, p = 0.0001), intermediate (5.3%) and low (1.1%) risk categories of death or myocardial infarction.

CONCLUSIONS

NT-proBNP provides incremental prognostic information above that given by clinical history and exercise testing in patients with chest pain without ST-segment deviation and negative troponin.

Authors+Show Affiliations

Servei de Cardiologia, Hospital Clínic Universitari, Universitat de València, València, Spain. sanchis_juafor@gva.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17639094

Citation

Sanchis, J, et al. "Combination of Clinical Risk Profile, Early Exercise Testing and Circulating Biomarkers for Evaluation of Patients With Acute Chest Pain Without ST-segment Deviation or Troponin Elevation." Heart (British Cardiac Society), vol. 94, no. 3, 2008, pp. 311-5.
Sanchis J, Bosch X, Bodí V, et al. Combination of clinical risk profile, early exercise testing and circulating biomarkers for evaluation of patients with acute chest pain without ST-segment deviation or troponin elevation. Heart. 2008;94(3):311-5.
Sanchis, J., Bosch, X., Bodí, V., Bellera, N., Núñez, J., Benito, B., ... Llècer, A. (2008). Combination of clinical risk profile, early exercise testing and circulating biomarkers for evaluation of patients with acute chest pain without ST-segment deviation or troponin elevation. Heart (British Cardiac Society), 94(3), pp. 311-5.
Sanchis J, et al. Combination of Clinical Risk Profile, Early Exercise Testing and Circulating Biomarkers for Evaluation of Patients With Acute Chest Pain Without ST-segment Deviation or Troponin Elevation. Heart. 2008;94(3):311-5. PubMed PMID: 17639094.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combination of clinical risk profile, early exercise testing and circulating biomarkers for evaluation of patients with acute chest pain without ST-segment deviation or troponin elevation. AU - Sanchis,J, AU - Bosch,X, AU - Bodí,V, AU - Bellera,N, AU - Núñez,J, AU - Benito,B, AU - Ordóñez,J, AU - Consuegra,L, AU - Heras,M, AU - Llècer,A, Y1 - 2007/07/16/ PY - 2007/7/20/pubmed PY - 2008/4/29/medline PY - 2007/7/20/entrez SP - 311 EP - 5 JF - Heart (British Cardiac Society) JO - Heart VL - 94 IS - 3 N2 - OBJECTIVE: To investigate the combination of clinical data, exercise testing and biomarkers for the evaluation of patients with chest pain without ST-segment deviation or troponin elevation. DESIGN: Prospective cohort design. SETTTING: Two teaching hospitals in Spain. PATIENTS: 422 patients presenting to the emergency department were studied. Leukocyte count, C-reactive protein (CRP), pregnancy-associated plasma protein A (PAPP-A) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were determined. A validated clinical risk score (number of points according to pain characteristics and risk factors) was used for clinical evaluation and early exercise testing was performed. MAIN OUTCOME MEASURES: Adverse events (death, myocardial infarction or revascularisation) during a median 60 weeks follow-up. RESULTS: By receiver operating characteristic curve analysis, the association between death or myocardial infarction and adverse events was not significant with leukocyte count (p = 0.3, p = 0.3) or CRP (p = 0.5, p = 0.8), was borderline significant with PAPP-A (p = 0.07, p = 0.04) and strongly significant with NT-pro-BNP (p = 0.0001, p = 0.0001). By Cox regression including clinical risk score, exercise testing result and biomarkers, exercise testing was the independent predictor of revascularisation (p = 0.0001), whereas risk score (p = 0.03) and NT-proBNP (p = 0.0004) predicted death or myocardial infarction. The inclusion of NT-proBNP improved the accuracy of the model for death or myocardial infarction (C-statistic 0.84 versus 0.76, p = 0.01). The combination of clinical score and NT-proBNP afforded the stratification in high (17.2%, p = 0.0001), intermediate (5.3%) and low (1.1%) risk categories of death or myocardial infarction. CONCLUSIONS: NT-proBNP provides incremental prognostic information above that given by clinical history and exercise testing in patients with chest pain without ST-segment deviation and negative troponin. SN - 1468-201X UR - https://www.unboundmedicine.com/medline/citation/17639094/Combination_of_clinical_risk_profile_early_exercise_testing_and_circulating_biomarkers_for_evaluation_of_patients_with_acute_chest_pain_without_ST_segment_deviation_or_troponin_elevation_ L2 - http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=17639094 DB - PRIME DP - Unbound Medicine ER -