背景:胸痛是急诊室转诊的普遍原因,并提出了诊断挑战。医生必须仔细区分心脏和非心脏原因,包括各种血管和心外血管疾病。然而,关键是不要忽视急性冠脉综合征(ACS)等严重疾病.急性心肌梗死(AMI)的诊断和早期出院管理变得困难时,传统的临床标准,心电图,肌钙蛋白值不足。最近,重点已转移到"多标记"方法,以提高胸痛患者的诊断准确性和预后.
方法:这种观察,prospective,涉及单中心研究,知情同意,到急诊科就诊的360名患者患有典型的胸痛,其中包括一个由120名健康受试者组成的对照组。除了常规检查,包括测试hsTnI(西门子TNIH套件),根据0-1h算法,还对每位患者的生化标志物sST2(致瘤性抑制-2)和suPAR(可溶性尿激酶纤溶酶原激活物受体)进行了评估.进行12个月的随访以监测结果和不良事件。
结果:我们确定了两组患者:一组hsTnI阳性(112例),sST2>24.19ng/mL,suPAR>2.9ng/mL,诊断为ACS;和阴性的一个(136例)低水平的hsTnI,suPAR<2.9ng/mL,并且sST2<24.19ng/mL。在12个月的随访中,阴性组未观察到不良事件.在中间组中,hsTnI在6ng/L和缺血极限之间的患者,sST2>29.1ng/mL,suPAR>2.9ng/mL,在随访期间显示出最高的不良事件概率,而sST2<24.19ng/mL和suPAR<2.9ng/mL的患者在12个月时具有更好的结局,且无不良事件。
结论:我们的数据表明sST2和suPAR,和HSTnI一起,可能对ACS患者的预后有用,提供有关内皮损伤的其他信息。这些生物标志物可以指导进一步诊断研究的临床决策。此外,suPAR和sST2有望用于胸痛患者的事件预测。将它们整合到PS的标准方法中可以促进更有效的患者管理,允许根据个人风险安全释放或及时入院。
BACKGROUND: Chest pain is a prevalent reason for emergency room referrals and presents diagnostic challenges. The physician must carefully differentiate between cardiac and noncardiac causes, including various vascular and extracardiovascular conditions. However, it is crucial not to overlook serious conditions such as acute coronary syndrome (ACS). Diagnosis of acute myocardial infarction (AMI) and early discharge management become difficult when traditional clinical criteria, ECG, and troponin values are insufficient. Recently, the focus has shifted to a \"multi-marker\" approach to improve diagnostic accuracy and prognosis in patients with chest pain.
METHODS: This observational, prospective, single-center study involved, with informed consent, 360 patients presenting to the emergency department with typical chest pain and included a control group of 120 healthy subjects. In addition to routine examinations, including tests for hsTnI (Siemens TNIH kit), according to the 0-1 h algorithm, biochemical markers sST2 (tumorigenicity suppression-2) and suPAR (soluble urokinase plasminogen activator receptor) were also evaluated for each patient. A 12-month follow-up was conducted to monitor outcomes and adverse events.
RESULTS: We identified two groups of patients: a positive one (112 patients) with high levels of hsTnI, sST2 > 24.19 ng/mL, and suPAR > 2.9 ng/mL, diagnosed with ACS; and a negative one (136 patients) with low levels of hsTnI, suPAR < 2.9 ng/mL, and sST2 < 24.19 ng/mL. During the 12-month follow-up, no adverse events were observed in the negative group. In the intermediate group, patients with hsTnI between 6 ng/L and the ischemic limit, sST2 > 29.1 ng/mL and suPAR > 2.9 ng/mL, showed the highest probability of adverse events during follow-up, while those with sST2 < 24.19 ng/mL and suPAR < 2.9 ng/mL had a better outcome with no adverse events at 12 months.
CONCLUSIONS: Our data suggest that sST2 and suPAR, together with hsTnI, may be useful in the prognosis of cardiovascular patients with ACS, providing additional information on endothelial damage. These biomarkers could guide the clinical decision on further diagnostic investigations. In addition, suPAR and sST2 emerge as promising for event prediction in patients with chest pain. Their integration into the standard approach in PS could facilitate more efficient patient management, allowing safe release or timely admission based on individual risk.