Serological biomarkers in the risk stratification of patients with suspected ACS and high sensitivity troponin T levels below the 99th percentile



Jones, Julia
(2022) Serological biomarkers in the risk stratification of patients with suspected ACS and high sensitivity troponin T levels below the 99th percentile. Doctor of Medicine thesis, University of Liverpool.

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Abstract

Introduction Coronary Heart Disease (CHD) kills almost 70,000 people each year in the UK and is responsible for considerable NHS resource expenditure. Accurate risk stratification could improve patient care and reduce NHS expenditure. The aim of this thesis is to assess the incremental role of biomarkers to risk scores in the risk stratification of patients who present with suspected Acute Coronary Syndrome (ACS) and have high sensitivity troponin T levels below the 99th percentile. Methods A prospective observational study in a single centre in a large university teaching hospital. Inclusion criteria consisted of chest pain that was suspected to be ACS with Hs-cTnT levels below the 99th percentile when measured between 6-12 hours post pain. Exclusion criteria included clear non-cardiac pain, chronic atrial fibrillation, heart failure and recent ACS. The biomarkers HFABP, GDF-15, NTproBNP, Galectin-3, HSCRP, Hs-cTnT and Hs-cTnI were measured, to determine if these markers could improve risk stratification in isolation or when combined with the HEART, TIMI and GRACE risk scores. Results 487 patients were included with a median follow up of 5.83 years. 48 experienced MACE and 42 patients experienced all-cause mortality during follow up. There were high levels of cardiovascular risk factors with 85% of patients having at least 1 traditional cardiovascular risk factor (excluding gender) and nearly a third of patients (28%) having a history of angina. Over 40% of patients were discharged without a firm diagnosis. MACE occurred as an inpatient in 3% and at 8-weeks in 4% of patients. 7% of patients represented to the same department at 8-weeks. The HEART and TIMI score perform well in the risk stratification of these patients with a C-Statistic of 0.76 and 0.74 respectively for 12-month MACE. The HEART score is more favourable at ruling out future early MACE. The high sensitivity troponin values, even below the 99th percentile provide incremental independent information beyond each risk score. GDF-15 may have a role in the risk stratification of patients, particularly in combination with the HEART and TIMI scores. Conclusion The HEART score performs well in the prediction and rule-out of MACE and the incorporation of high sensitivity troponin levels improves these scores. GDF-15 appears to be a promising biomarker that provides incremental information beyond risk scores.

Item Type: Thesis (Doctor of Medicine)
Divisions: Faculty of Health and Life Sciences
Depositing User: Symplectic Admin
Date Deposited: 14 Feb 2022 16:06
Last Modified: 18 Aug 2022 07:11
DOI: 10.17638/03146507
Supervisors:
  • Khand, Aleem
  • Kemp, Graham
  • Moots, Robert
URI: https://livrepository.liverpool.ac.uk/id/eprint/3146507