Differentiating type 1 and 2 acute myocardial infarctions using the N-terminal pro B-type natriuretic peptide/cardiac troponin T ratio.
Am J Emerg Med
; 36(10): 1849-1854, 2018 10.
Article
em En
| MEDLINE
| ID: mdl-30007549
ABSTRACT
PURPOSE:
Differentiation of type 1 (T1MI) from type 2 myocardial infarction (T2MI) is important as recommended treatments for each differ. Patients with T2MI may have more/earlier cardiac wall stress resulting in an increased N-terminal pro B-type natriuretic peptide (NT-proBNP)/cTnT generation 5 ratio (cTnT Gen 5).METHODS:
Emergency Department (ED) patients presenting with symptoms suspicious for acute coronary syndrome (ACS) were enrolled from 2013 to 2015. Baseline blood samples were collected within 60â¯min of a triage ECG, with additional draws at 30, 60 and 180â¯min. NT-proBNP and cTnT Gen 5 levels were measured later in an independent laboratory. Acute myocardial infarction (AMI) was adjudicated using the Third Universal Definition of Myocardial Infarction.RESULTS:
575 patients were enrolled with 44 (7.7%) having AMI [25 T1MI (59.1%) and 18 T2MI (40.9%)]. Patient characteristics showed very few AMI type differences so accurate clinical differentiation was difficult. The median NT-proBNP/cTnT Gen 5 ratios were significantly higher in T2MI when compared to T2MI at baseline and 30, 60 and 180â¯min later [7.3 v 53.0 (pâ¯=â¯0.003), 5.8 v 49.5 (pâ¯=â¯0.002), 6.3 v 47.5 (pâ¯=â¯0.003) and 4.3 v 33.7 (pâ¯=â¯0.016) respectively].CONCLUSIONS:
The clinical determination of whether an AMI is type 1 or 2 is difficult as the ED patient characteristics of each are similar. The NT-proBNP/cTnT Gen 5 ratio can aid in making this differentiation. Additional multicenter trials are needed to validate our results.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fragmentos de Peptídeos
/
Troponina T
/
Peptídeo Natriurético Encefálico
/
Infarto do Miocárdio
Tipo de estudo:
Diagnostic_studies
/
Observational_studies
Limite:
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Am J Emerg Med
Ano de publicação:
2018
Tipo de documento:
Article