Early diagnosis of acute coronary syndrome

Katus H, Ziegler A, Ekinci O, Giannitsis E, Stough WG, Achenbach S, Blankenberg S, Brueckmann M, Collinson P, Comaniciu D, Crea F, Dinh W, Ducrocq G, Flachskampf FA, Fox KAA, Friedrich MG, Hebert KA, Himmelmann A, Hlatky M, Lautsch D, Lindahl B, Lindholm D, Mills NL, Minotti G, Moeckel M, Omland T, Semjonow V (2017)

Publication Type: Journal article

Publication year: 2017

Journal

Book Volume: 38

Pages Range: 3049-3055

Journal Issue: 41

DOI: 10.1093/eurheartj/ehx492

Abstract

The diagnostic evaluation of acute chest pain has been augmented in recent years by advances in the sensitivity and precision of cardiac troponin assays, new biomarkers, improvements in imaging modalities, and release of new clinical decision algorithms. This progress has enabled physicians to diagnose or rule-out acute myocardial infarction earlier after the initial patient presentation, usually in emergency department settings, which may facilitate prompt initiation of evidence-based treatments, investigation of alternative diagnoses for chest pain, or discharge, and permit better utilization of healthcare resources. A non-trivial proportion of patients fall in an indeterminate category according to rule-out algorithms, and minimal evidence-based guidance exists for the optimal evaluation, monitoring, and treatment of these patients. The Cardiovascular Round Table of the ESC proposes approaches for the optimal application of early strategies in clinical practice to improve patient care following the review of recent advances in the early diagnosis of acute coronary syndrome. The following specific 'indeterminate' patient categories were considered: (i) patients with symptoms and high-sensitivity cardiac troponin <99th percentile; (ii) patients with symptoms and high-sensitivity troponin <99th percentile but above the limit of detection; (iii) patients with symptoms and high-sensitivity troponin >99th percentile but without dynamic change; and (iv) patients with symptoms and high-sensitivity troponin >99th percentile and dynamic change but without coronary plaque rupture/erosion/dissection. Definitive evidence is currently lacking to manage these patients whose early diagnosis is 'indeterminate' and these areas of uncertainty should be assigned a high priority for research.

Authors with CRIS profile

Involved external institutions

Hôpital Bichat-Claude-Bernard (CHU, APHP) France (FR) Catholic University of the Sacred Heart / Università Cattolica del Sacro Cuore Italy (IT) University of Edinburgh United Kingdom (GB) Siemens AG, Healthcare Sector Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Uppsala University Sweden (SE) St George's Hospital United Kingdom (GB) AstraZenaca R&D Sweden (SE) Charité - Universitätsmedizin Berlin Germany (DE) Boehringer Ingelheim Pharma GmbH & Co. KG Germany (DE) Akershus University Hospital / Akershus universitetssykehus (Ahus) Norway (NO) Merck & Co., Inc. / Merck Sharp & Dohme Corp (MSD) United States (USA) (US) Campbell University United States (USA) (US) GE Healthcare Sweden Sweden (SE) Campus Bio-Medico University of Rome Italy (IT) Roche Diagnostics GmbH Germany (DE) Stanford University United States (USA) (US) McGill University Canada (CA) Philips Electronics Nederland BV Netherlands (NL) Ruprecht-Karls-Universität Heidelberg Germany (DE) Bayer HealthCare AG Germany (DE)

How to cite

APA:

Katus, H., Ziegler, A., Ekinci, O., Giannitsis, E., Stough, W.G., Achenbach, S.,... Semjonow, V. (2017). Early diagnosis of acute coronary syndrome. European Heart Journal, 38(41), 3049-3055. https://doi.org/10.1093/eurheartj/ehx492

MLA:

Katus, Hugo, et al. "Early diagnosis of acute coronary syndrome." European Heart Journal 38.41 (2017): 3049-3055.

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