Multi-marker strategy of natriuretic peptide with either conventional or high-sensitivity troponin-T for acute coronary syndrome diagnosis in emergency department patients with chest pain: From the “Rule Out Myocardial Infarction Using Computer Assisted Tomography” (ROMICAT) trial
American Heart Journal, 05/24/2012
Truong QA et al. – Among emergency department patients with low–intermediate likelihood of acute coronary syndrome (ACS), combining natriuretic peptides with either conventional or highly–sensitive troponin improved discriminatory capacity and allowed for better reclassification of ACS, findings supported by structural and functional CT results.Methods
- In 328 patients (53 ± 12 years, 63% men) with an initially negative conventional troponin and nonischemic electrocardiogram who underwent 64–slice cardiac computed tomography (CT), the authors measured conventional troponin–T (cTnT), high–sensitivity troponin–T (hsTnT), N–terminal pro–B type natriuretic peptide, and mid–regional pro–atrial natriuretic peptide.
- ACS was defined as myocardial infarction or unstable angina.
- CT was evaluated for coronary plaque, stenosis, and regional wall motion abnormality.
- Patients with ACS (n = 29, 9%) had higher concentrations of each biomarker compared to those without (all P < .01).
- Adding natriuretic peptides, especially N–terminal pro–B type natriuretic peptide, to both cTnT or hsTnT improved the C–statistics and net reclassification index for ACS, largely driven by correctly reclassifying events.
- Dual–negative marker results improved sensitivity (cTnT 38% to 83%–86%, hsTnT 59% to 86%–90%; all P < .01) and negative predictive value (cTnT 94% to 97%–98%, hsTnT 96% to 97%–98%) for ACS.
- Patients with dual–negative markers had the lowest percentage of CT coronary plaque, stenosis, and regional wall motion abnormality (all P–trend <.001).