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Diagnostic accuracy of cardiovascular risk factors for an acute coronary syndrome

Session Poster session 5

Speaker Maria Rubini Gimenez

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Non-ST-Elevation Myocardial Infarction (NSTEMI)
  • Session type : Poster Session

Authors : M Rubini Gimenez (Basel,CH), L Cullen (Brisbane,AU), M Than (Christchurch,NZ), J Greenslade (Brisbane,AU), R Twerenbold (Basel,CH), J Boeddinghaus (Basel,CH), T Nestelberger (Basel,CH), K Wildi (Basel,CH), P Badertscher (Basel,CH), J Pickering (Christchurch,NZ), C Mueller (Basel,CH)

Authors:
M. Rubini Gimenez1 , L. Cullen2 , M. Than3 , J. Greenslade2 , R. Twerenbold1 , J. Boeddinghaus1 , T. Nestelberger1 , K. Wildi1 , P. Badertscher1 , J. Pickering3 , C. Mueller1 , 1University Hospital Basel, Department of Cardiology - Basel - Switzerland , 2Royal Brisbane and Women's Hospital, Emergency Department - Brisbane - Australia , 3Christchurch Hospital, Emergency Department - Christchurch - New Zealand ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 1002

Aim: We assessed the diagnostic performance of cardiovascular risk factors (CVRF) as cardiac risk burden for acute coronary syndrome (ACS) and acute myocardial infarction (AMI).

Methods: In a prospective international multicenter study, we enrolled patients presenting to the Emergency Department (ED) with suspected AMI. The adjudication of the final diagnosis was performed by two independent cardiologists. Patients were stratified according to the presence or absence of known coronary artery disease (CAD). Diagnostic accuracy for ACS and AMI was the primary endpoint. Prognostic accuracy for death and/or future AMI was the secondary endpoint.

Results: We included a total of 2830 patients. Among 1860 patients without known CAD, ACS and AMI were the adjudicated final diagnosis in 21% and 17% of patients, respectively. Overall cardiovascular risk profile quantified by the number of CVRF had modest diagnostic accuracy with an area under the receiver-operating-characteristics curve (AUC) of 0.68 (95% CI, 0.65–0.71) for ACS and 0.65 (95% CI, 0.62–0.69) for AMI, which both were inferior to high-sensitivity (hs) cardiac troponin (cTn) T at presentation (0.90; 95% CI 0.89–0.92 and 0.95; 95% CI 0.93–0.96, respectively, both p<0.001), and did not provide diagnostic added value to hs-cTn (p=ns). Prognostic accuracy of the number of CVRF for death and/or future AMI also was modest (AUC 0.59, 95% CI 0.54–0.64). Diagnostic and prognostic accuracy of CVRF were poor in 970 patients with known CAD. These findings were confirmed in an external validation cohort from Australia and New Zealand.

Conclusion: CVRF have only modest diagnostic and prognostic value in patients presenting with suspected ACS to the ED and their absence does not obviate the need for ECG and cTn testing.

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