{"id":539,"date":"2019-01-11T16:11:34","date_gmt":"2019-01-11T16:11:34","guid":{"rendered":"http:\/\/clinicalbiochemistry.net\/?page_id=539"},"modified":"2019-02-04T08:32:53","modified_gmt":"2019-02-04T08:32:53","slug":"early-vascular-markers-of-acute-coronary-syndromes","status":"publish","type":"page","link":"http:\/\/clinicalbiochemistry.net\/?page_id=539","title":{"rendered":"Early Vascular Markers of Acute Coronary Syndromes."},"content":{"rendered":"\n<p class=\"has-medium-font-size\"><strong>Purpose<\/strong>: To study the utility of incorporating early vascular activation markers into a clinical decision rule to risk stratify patients according to their risk of a significant myocardial event.<\/p>\n\n\n<figure class=\"wp-block-image\"><img data-attachment-id=\"54\" data-permalink=\"http:\/\/clinicalbiochemistry.net\/?attachment_id=54\" data-orig-file=\"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2017\/12\/Cardiac-Marker-Test-Pages.png?fit=800%2C533\" data-orig-size=\"800,533\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Cardiac Marker Test &#8211; Pages\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2017\/12\/Cardiac-Marker-Test-Pages.png?fit=300%2C200\" data-large-file=\"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2017\/12\/Cardiac-Marker-Test-Pages.png?fit=750%2C500\" loading=\"lazy\" width=\"750\" height=\"500\" src=\"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2017\/12\/Cardiac-Marker-Test-Pages.png?resize=750%2C500\" alt=\"\" class=\"wp-image-54\" srcset=\"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2017\/12\/Cardiac-Marker-Test-Pages.png?w=800 800w, https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2017\/12\/Cardiac-Marker-Test-Pages.png?resize=300%2C200 300w, https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2017\/12\/Cardiac-Marker-Test-Pages.png?resize=768%2C512 768w\" sizes=\"(max-width: 750px) 100vw, 750px\" data-recalc-dims=\"1\" \/><\/figure>\n\n\n<p class=\"has-medium-font-size\"><strong>Methods:&nbsp;<\/strong>We recruited a cohort of patients with symptoms suggest of&nbsp;&nbsp;ACS presenting to the emergency department. Blood was obtained to determine if early markers of vascular activation can be combined with clinical findings to create a clinical decision rule capable of the early risk stratification of patients with ACS. The presence of ACS will be determined by Troponin estimation and clinical follow up.<\/p>\n\n\n<p class=\"has-medium-font-size\"><strong>Study Outcome:<\/strong> A combined clinical and biochemical clinical decision rule to risk stratify patients with symptoms suggest of ACS in the emergency setting.<\/p>\n\n\n<h2>Early Vascular Markers of Acute Coronary Syndromes Study Publications<\/h2>\n\n\n\t<div class=\"wppap-main-wrapper wpapap-clearfix\">\n\t\t<ul id=\"thumbs-1\" class=\"wppap-thumbs\" data-conf=\"{&quot;grid&quot;:3}\">\n\t\t\t\t<li class=\"thum-list\">\n\t\t\t\t\t<a data-mfp-src=\"#thumb1\" href=\"#\" class=\"wppap-thumbnail\" style=\"background-image: url('http:\/\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Tn-How-low-can-you-go-e1549807753211.png')\">\n\t\t\t\t\t\t<span class=\"wppap-description\">cTn Threshold<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\n\t\t\t\t<li class=\"thum-list\">\n\t\t\t\t\t<a data-mfp-src=\"#thumb2\" href=\"#\" class=\"wppap-thumbnail\" style=\"background-image: url('http:\/\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Modified-TIMI-1-e1549807787719.png')\">\n\t\t\t\t\t\t<span class=\"wppap-description\">Modified TIMI<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\n\t\t\t\t<li class=\"thum-list\">\n\t\t\t\t\t<a data-mfp-src=\"#thumb3\" href=\"#\" class=\"wppap-thumbnail\" style=\"background-image: url('http:\/\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/JACC-paper-e1549807840111.png')\">\n\t\t\t\t\t\t<span class=\"wppap-description\">Undetectable hs-cTnT<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\n\t\t\t\t<li class=\"thum-list\">\n\t\t\t\t\t<a data-mfp-src=\"#thumb4\" href=\"#\" class=\"wppap-thumbnail\" style=\"background-image: url('http:\/\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Quanti-HFABP-e1549807872944.png')\">\n\t\t\t\t\t\t<span class=\"wppap-description\">FABP-ulous<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\n\t\t\t\t<li class=\"thum-list\">\n\t\t\t\t\t<a data-mfp-src=\"#thumb5\" href=\"#\" class=\"wppap-thumbnail\" style=\"background-image: url('http:\/\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Symptoms-and-Signs-e1549807905811.png')\">\n\t\t\t\t\t\t<span class=\"wppap-description\">Symptoms and Signs in ACS<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\n\t\t\t\t<li class=\"thum-list\">\n\t\t\t\t\t<a data-mfp-src=\"#thumb6\" href=\"#\" class=\"wppap-thumbnail\" style=\"background-image: url('http:\/\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Risk-factors-for-ED-diagnosis-e1549807935709.png')\">\n\t\t\t\t\t\t<span class=\"wppap-description\">Risk Factors in AMI<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\n\t\t\t\t<li class=\"thum-list\">\n\t\t\t\t\t<a data-mfp-src=\"#thumb7\" href=\"#\" class=\"wppap-thumbnail\" style=\"background-image: url('http:\/\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/P-Selectin-1-e1549807984127.png')\">\n\t\t\t\t\t\t<span class=\"wppap-description\">P-Selectin in AMI<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\t\t<\/ul>\n\n\t\t<div class=\"wppap-portfolio-content\">\n\n\t\t\t\n\t\t\t\t<div id=\"thumb1\">\n\n\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-medium-12 wppap-columns wppap-right-column\">\n\t\t\t\t\t\t<div class=\"wppap-right-content\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-title\">cTn Threshold<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-content\"><p>The authors compared the prognostic implications of placing the diagnostic troponin cut-off at the 99th percentile and at the lowest concentration with a CV &lt;10% (functional sensitivity).<\/p>\n<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/clinicalbiochemistry.net\/?page_id=654\" class=\"wppap-project-url-btn\" target=\"_blank\">View Project<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t \n\t\t\t\t<div id=\"thumb2\">\n\n\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-medium-12 wppap-columns wppap-right-column\">\n\t\t\t\t\t\t<div class=\"wppap-right-content\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-title\">Modified TIMI<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-content\"><p>The thrombolysis in myocardial infarction (TIMI) risk score has been shown to risk stratify patients with suspected acute coronary syndromes (ACS) effectively in the emergency department (ED) but cannot be used to guide patient disposition. We aimed to evaluate whether modifying the TIMI risk score to give greater weighting to ischaemic ECG changes and troponin elevations would enhance its risk stratification and thus potentially facilitate safe patient discharge after 12-h troponin testing.<\/p>\n<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/clinicalbiochemistry.net\/?page_id=650\" class=\"wppap-project-url-btn\" target=\"_blank\">View Project<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t \n\t\t\t\t<div id=\"thumb3\">\n\n\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-medium-12 wppap-columns wppap-right-column\">\n\t\t\t\t\t\t<div class=\"wppap-right-content\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-title\">Undetectable hs-cTnT<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-content\"><p>This paper sought to evaluate whether high sensitivity troponin (hs-cTnT) can immediately exclude acute myocardial infarction (AMI) at a novel \u2018rule out\u2019 cut-off.<\/p>\n<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/clinicalbiochemistry.net\/?page_id=646\" class=\"wppap-project-url-btn\" target=\"_blank\">View Project<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t \n\t\t\t\t<div id=\"thumb4\">\n\n\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-medium-12 wppap-columns wppap-right-column\">\n\t\t\t\t\t\t<div class=\"wppap-right-content\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-title\">FABP-ulous<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-content\"><p>Many Emergency Departments (EDs) utilise \u2018triple marker\u2019 testing with CK-MB, myoglobin and troponin I (cTnI) to exclude acute myocardial infarction (AMI) within hours of presentation. We evaluated the ability of 8 biomarkers to rapidly exclude AMI at the point of presentation and investigated whether \u2018triple marker\u2019 testing represents the optimal multimarker strategy.<\/p>\n<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/clinicalbiochemistry.net\/?page_id=641\" class=\"wppap-project-url-btn\" target=\"_blank\">View Project<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t \n\t\t\t\t<div id=\"thumb5\">\n\n\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-medium-12 wppap-columns wppap-right-column\">\n\t\t\t\t\t\t<div class=\"wppap-right-content\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-title\">Symptoms and Signs in ACS<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-content\"><p><span lang=\"EN-US\">Patient history and physical examination are widely accepted as cornerstones of diagnosis in modern medicine. We aimed to assess the value of individual historical and examination findings for diagnosing acute myocardial infarction (AMI) and predicting adverse cardiac events in undifferentiated Emergency Department (ED) patients with chest pain. <\/span><\/p>\n<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/clinicalbiochemistry.net\/?page_id=637\" class=\"wppap-project-url-btn\" target=\"_blank\">View Project<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t \n\t\t\t\t<div id=\"thumb6\">\n\n\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-medium-12 wppap-columns wppap-right-column\">\n\t\t\t\t\t\t<div class=\"wppap-right-content\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-title\">Risk Factors in AMI<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-content\"><p><span lang=\"EN-US\">Hypertension, hyperlipidaemia, diabetes mellitus, tobacco smoking and a family history of premature coronary artery disease are known to be risk factors for the development of coronary artery disease. We sought to determine whether these traditional risk factors aid the diagnosis of acute myocardial infarction (AMI) in the Emergency Department (ED). <\/span><\/p>\n<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/clinicalbiochemistry.net\/?page_id=629\" class=\"wppap-project-url-btn\" target=\"_blank\">View Project<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t \n\t\t\t\t<div id=\"thumb7\">\n\n\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-medium-12 wppap-columns wppap-right-column\">\n\t\t\t\t\t\t<div class=\"wppap-right-content\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-title\">P-Selectin in AMI<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wppap-content\"><p><span lang=\"EN-US\">P-selectin has early diagnostic value for AMI and prognostic value independent of cTnT and ECG findings. The combination of P-selectin, cTnT and ECG has high NPV.<\/span><\/p>\n<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/clinicalbiochemistry.net\/?page_id=624\" class=\"wppap-project-url-btn\" target=\"_blank\">View Project<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t \t\t<\/div>\n\t<\/div>\n\t\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Purpose: To study the utility of incorporating early vascular activation markers into a clinical decision rule to risk stratify patients according to their risk of a significant myocardial event. Methods:&nbsp;We recruited a cohort of patients with symptoms suggest of&nbsp;&nbsp;ACS presenting<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"jetpack_post_was_ever_published":false,"_links_to":"","_links_to_target":""},"jetpack_shortlink":"https:\/\/wp.me\/P9tPlw-8H","jetpack-related-posts":[{"id":136,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=136","url_meta":{"origin":539,"position":0},"title":"T-MACS","date":"December 22, 2017","format":false,"excerpt":"Body, R., Carlton, E., Sperrin, M., Lewis, P.S., Burrows, G., Carley, S., McDowell, G., Buchan, I., Greaves, K. & Mackway-Jones, K. (2017). Troponin only Manchester Acute Coronary Syndromes (T-MACS) decision aid: single biomarker re-derivation and external validation in three cohorts. Emerg Med J 34 pp. 349-356 Background The original Manchester\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2017\/12\/Cardiac-Marker-Test-Pages-300x200.png?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":549,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=549","url_meta":{"origin":539,"position":1},"title":"PhD Project: BEST Study","date":"January 11, 2019","format":false,"excerpt":"Expediting the confirmation of acute myocardial infarction with point of care troponin and heart fatty acid binding protein testing to facilitate early intervention in emergency department Cardiac troponin is the reference standard biomarker for the diagnosis of acute myocardial infarction (AMI). In the appropriate clinical context, the detection of a\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":732,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=732","url_meta":{"origin":539,"position":2},"title":"Novel hs-cTn Assay with a Single Serum Test in ED.","date":"July 21, 2019","format":false,"excerpt":"3D illustration of Heart - Part of Human Organic. Objectives To evaluate diagnostic accuracy of a high-sensitivity cardiac troponin I (hs-cTnI) assay for acute coronary syndromes (ACS) in the Emergency Department (ED). The assay has high precision at low concentrations and can detect cTnI in 96.8% of healthy individuals.\u00a0 Methods\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/07\/Screenshot-2019-07-21-at-10.53.34-e1563702957497.png?fit=364%2C500&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":637,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=637","url_meta":{"origin":539,"position":3},"title":"Symptoms and Signs in ACS","date":"February 7, 2019","format":false,"excerpt":"Body, R., Carley, S., Wibberley, C.,\u00a0McDowell, G., Ferguson, J. & Mackway- Jones, K. (2010) \u2018The value of symptoms and signs in the emergent diagnosis of acute coronary syndromes.\u2019\u00a0Resuscitation81 pp. 281-286.\u00a0 Objective:Patient history and physical examination are widely accepted as cornerstones of diagnosis in modern medicine. We aimed to assess the\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Symptoms-and-Signs-e1549807905811.png?fit=400%2C311&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":568,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=568","url_meta":{"origin":539,"position":4},"title":"T-MACS and POCT Troponin","date":"January 17, 2019","format":false,"excerpt":"The Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid for rapid rule-in and rule-out of acute coronary syndromes using a contemporary point of care troponin assay Richard Body; Malak Almashali; Niall Morris; Phil Moss; Heather Jarman; Andrew Appelboam; Richard Parris; Louisa Chan; Alison Walker; Mark Harrison; Andrea Wootten; Garry McDowellc\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":121,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=121","url_meta":{"origin":539,"position":5},"title":"Research Papers","date":"December 22, 2017","format":false,"excerpt":"Body, R., McDowell, G., Carley, S., Ferguson, J. & Mackway-Jones, K. (2010) \u2018Diagnosing acute myocardial infarction with troponins: how low can you go?\u2019 Emerg Med J. 27 pp. 292-296. Body, R., Carley, S., Wibberley, C., McDowell, G., Ferguson, J. & Mackway- Jones, K. (2010) \u2018The value of symptoms and signs\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]}],"_links":{"self":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/539"}],"collection":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=539"}],"version-history":[{"count":9,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/539\/revisions"}],"predecessor-version":[{"id":665,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/539\/revisions\/665"}],"wp:attachment":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=539"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}