학술논문
Combining glucose and high-sensitivity cardiac troponin in the early diagnosis of acute myocardial infarction
Document Type
article
Author
Ana Yufera-Sanchez; Pedro Lopez-Ayala; Thomas Nestelberger; Karin Wildi; Jasper Boeddinghaus; Luca Koechlin; Maria Rubini Gimenez; Hüseyin Sakiz; Paolo Bima; Oscar Miro; F. Javier Martín-Sánchez; Michael Christ; Dagmar I. Keller; Danielle M. Gualandro; Damian Kawecki; Katharina Rentsch; Andreas Buser; Christian Mueller; The APACE Investigators
Source
Scientific Reports, Vol 13, Iss 1, Pp 1-13 (2023)
Subject
Language
English
ISSN
2045-2322
Abstract
Abstract Glucose is a universally available inexpensive biomarker, which is increased as part of the physiological stress response to acute myocardial infarction (AMI) and may therefore help in its early diagnosis. To test this hypothesis, glucose, high-sensitivity cardiac troponin (hs-cTn) T, and hs-cTnI were measured in consecutive patients presenting with acute chest discomfort to the emergency department (ED) and enrolled in a large international diagnostic study (NCT00470587). Two independent cardiologists centrally adjudicated the final diagnosis using all clinical data, including serial hs-cTnT measurements, cardiac imaging and clinical follow-up. The primary diagnostic endpoint was index non-ST-segment elevation MI (NSTEMI). Prognostic endpoints were all-cause death, and cardiovascular (CV) death or future AMI, all within 730-days. Among 5639 eligible patients, NSTEMI was the adjudicated final diagnosis in 1051 (18.6%) patients. Diagnostic accuracy quantified using the area under the receiver-operating characteristics curve (AUC) for the combination of glucose with hs-cTnT and glucose with hs-cTnI was very high, but not higher versus that of hs-cTn alone (glucose/hs-cTnT 0.930 [95% CI 0.922–0.937] versus hs-cTnT 0.929 [95% CI 0.922–0.937]; glucose/hs-cTnI 0.944 [95% CI 0.937–0.951] versus hs-cTnI 0.944 [95% CI 0.937–0.951]). In early-presenters, a dual-marker strategy (glucose