Abstract 15279: Early Rule-Out of Myocardial Infarction is Facilitated by Soluble FMS-Like Tyrosine Kinase-1
Background: Acute chest pain is one of the most common causes for admission to an emergency department. Up to one third of these patients suffer an acute coronary syndrome (ACS) whereas a large proportion could be discharged early. Aim of the present study is to evaluate soluble fms-like tyrosine kinase-1 (sFLT-1) as marker of angiogenesis compared to high sensitive troponin I (TnI) in early diagnosis and rule-out of myocardial infarction (MI) in low-risk patients.
Methods: Patients with suspected ACS were consecutively enrolled at three German study centers between 01/2007 and 12/2008. Troponin I using a contemporary and high sensitive assay (Abbott ARCHITECT STAT (hs)TnI) as well as sFLT-1 (Abbott ARCHITECT) was measured on admission. Patients without ST-elevation and/or clearly elevated contemporary sensitive TnI on admission (above WHO cut-off) were defined as a low-risk population.
Results: 1818 (66.4% male) patients were enrolled with 413 (22.7%) diagnosed as acute MI whereas in 1165 (64.1%) patients an ACS could be excluded. sFLT-1 was elevated in MI with 5710.7pg/mL compared to 302.4pg/mL in non-coronary chest pain patients (p<0.0001). In the overall population sFLT-1 yielded an area under the curve (AUC) in the receiver operator characteristics (ROC) analyses of 0.65 compared to 0.92/0.96 for contemporary/high sensitive TnI. An integrated discrimination improvement (IDI) model based on high sensitive TnI is enhanced by sFLT-1 with 4.0%(p<0.0001). 1176 patients were classified as low-risk of which 128 suffered a MI. In these low-risk patients contemporary and high sensitive TnI using the 99th percentile cut-off (32.0/30.0pg/mL) provided a negative and positive predictive value (NPV/PPV) of 95.0/73.8 and of 96.0/65.7% on admission. sFLT-1 on admission yielded a NPV/PPV of 92.7/18.9% alone and of 98.2/24.3% in combination with high sensitive TnI if using the 99th percentile of sFLT-1 (351.2pg/mL) as cut-off. The 97.5th percentile sFLT-1 threshold (336.2pg/mL) improved the NPV of the combination slightly to 98.4%.
Conclusion: In low-risk chest pain patients the combination of high sensitive TnI and sFLT-1, a biomarker with different pathophysiological background compared to TnI, measured on admission, improves early rule-out of MI.
- © 2011 by American Heart Association, Inc.