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Risk prediction in chest pain patients by biochemical markers including estimates of renal function
Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.ORCID iD: 0000-0002-2608-2062
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2008 (English)In: International Journal of Cardiology, ISSN 0167-5273, Vol. 128, no 2, 207-213 p.Article in journal (Refereed) Published
Abstract [en]

Background: Early risk stratification of patients with chest pain may be improved by combining cardiac Troponin I (cTnI) results and ECG findings with markers of left-ventricular dysfunction, inflammation or renal function. Methods: Serial measurements of cTnI were prospectively performed in 452 chest pain patients with a non-diagnostic ECG for AMI and admitted to the coronary care unit. NT-pro BNP, CRP, cystatin C and creatinine-clearance were retrospectively analyzed in admission samples. The prognostic value of these markers alone and in different combinations together with ECG findings was evaluated by multivariate logistic regression models. Results: During follow-up, 14 deaths and 21 myocardial (re)-infarctions occurred. Independent predictors for the combined endpoint of death or (re)-infarction were peak cTnI ≥ 0.1 μg/L within 24 h (OR 3.9, 95% confidence interval [CI]1.5-10.4), cystatin C ≥ 1.28 mg/L (OR 5.6, 95% CI 1.9-16.3) and NT-pro BNP ≥ 550 ng/L (OR 2.7, 95% CI 1.0-7.3). At 2 h from admission, a combination of cTnI ≥ 0.1 μg/L, an abnormal ECG and NT-pro BNP or cystatin C as a third variable resulted in a similar stratification of patients to different risk groups. Conclusion: cTnI, NT-pro BNP and cystatin C are strong risk predictors in patients with chest pain. For pragmatic reasons, a combination of cTnI ≥ 0.1 μg/L, ECG findings and a marker of renal function, preferably cystatin C, appears to be most appropriate for early risk stratification of these patients. © 2007 Elsevier Ireland Ltd. All rights reserved.

Place, publisher, year, edition, pages
2008. Vol. 128, no 2, 207-213 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-44740DOI: 10.1016/j.ijcard.2007.04.096Local ID: 77514OAI: diva2:265602
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2013-09-11

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