دورية أكاديمية
أعرض في EDS

Evaluating possible acute coronary syndrome in primary care: the value of signs, symptoms, and plasma heart-type fatty acid-binding protein (H-FABP). A diagnostic study.

التفاصيل البيبلوغرافية
العنوان: Evaluating possible acute coronary syndrome in primary care: the value of signs, symptoms, and plasma heart-type fatty acid-binding protein (H-FABP). A diagnostic study.
المؤلفون: Willemsen RT; General Practitioner, PhD, Department of Family Medicine, Maastricht University, Maastricht, the Netherlands robert.willemsen@maastrichtuniversity.nl., Winkens B; Assistant Professor, Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands., Kietselaer BL; Cardiologist, Department of Cardiology, Zuyderland Hospital, Heerlen, the Netherlands., Smolinska A; Assistant Professor, Department of Pharmacology & Toxicology, Maastricht University, Maastricht, the Netherlands., Buntinx F; Professor, Department of Public Health and Primary Care, Catholic University Leuven, Leuven, Belgium.; Professor, Department of Family Medicine, Maastricht University, Maastricht, the Netherlands., Glatz JF; Professor, Department of Genetics & Cell Biology, Maastricht University, Maastricht, the Netherlands., Dinant GJ; Professor, Department of Family Medicine, Maastricht University, Maastricht, the Netherlands.
المصدر: BJGP open [BJGP Open] 2019 Oct 29; Vol. 3 (3). Date of Electronic Publication: 2019 Oct 29 (Print Publication: 2019).
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Royal College of General Practitioners Country of Publication: England NLM ID: 101713531 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 2398-3795 (Electronic) Linking ISSN: 23983795 NLM ISO Abbreviation: BJGP Open Subsets: PubMed not MEDLINE
أسماء مطبوعة: Original Publication: London : Royal College of General Practitioners, [2017]-
مستخلص: Background: Additional diagnostic means could be of added value when evaluating possible acute coronary syndrome (ACS) in primary care.
Aim: To determine whether heart-type fatty acid-binding protein (H-FABP)-based point-of-care (POC) biomarker testing, embedded in a clinical decision rule (CDR), is helpful to the GP when evaluating possible ACS.
Design & Setting: A prospective, non-randomised, double-blinded, diagnostic derivation study was undertaken, with a delayed-type cross-sectional diagnostic model among GPs in the Netherlands and Belgium.
Method: Signs and symptoms predicting acute myocardial infarction (AMI) or ACS were identified using both logistic regression analysis, and classification and regression trees (CART). Diagnostic values of the POC H-FABP test (cut-off value 4 ng/ml) alone and as part of a CDR were determined.
Results: A total of 303 participants (48.8% male) with chest pain or discomfort who had consulted a GP were enrolled. ACS was found in 32 (10.6%) of these 303 patients. For ACS, sensitivity and negative predictive value (NPV) of the POC H-FABP test was 25.8% (95% confidence interval [CI] = 12.5 to 44.9) and 91.6% (95% CI = 87.6% to 94.5%), respectively. The area under the receiver operating curve of the optimal CDR was 0.78 for ACS.
Conclusion: Sensitivity of the current H-FABP POC test (cut-off value 4 ng/ml) as a stand-alone test is poor, either owing to limitations of the marker or of the test device. Usability of a CDR derived from these results is doubtful: the number of ACS cases missed by the GP is reduced but, as a consequence, disproportionally more ACS-negative patients are referred.
(Copyright © 2019, The Authors.)
References: J Thromb Thrombolysis. 2013 Nov;36(4):361-7. (PMID: 23328883)
J Fam Pract. 1994 Apr;38(4):345-52. (PMID: 8163958)
J Clin Epidemiol. 2007 Nov;60(11):1116-22. (PMID: 17938052)
Prim Health Care Res Dev. 2018 Mar;19(2):176-188. (PMID: 29249206)
Am J Cardiol. 1997 Sep 1;80(5):563-8. (PMID: 9294982)
QJM. 1998 Mar;91(3):239-44. (PMID: 9604076)
Int J Cardiol. 2013 Sep 30;168(2):1485-9. (PMID: 23332896)
JAMA. 2013 Nov 27;310(20):2191-4. (PMID: 24141714)
Eur Heart J. 2011 Dec;32(23):2999-3054. (PMID: 21873419)
Eur J Gen Pract. 2009;15(3):141-6. (PMID: 19883149)
BMC Fam Pract. 2014 Dec 12;15:203. (PMID: 25738970)
Ann Intern Med. 2017 May 16;166(10):689-697. (PMID: 28437795)
Br J Gen Pract. 2007 Jul;57(540):538-46. (PMID: 17727746)
Swiss Med Wkly. 2008 Jun 14;138(23-24):340-7. (PMID: 18561039)
Heart. 2017 Nov;103(21):1727-1732. (PMID: 28634285)
Heart. 2005 Feb;91(2):229-30. (PMID: 15657244)
Br J Gen Pract. 2012 Jun;62(599):e415-21. (PMID: 22687234)
Eur Heart J. 1996 Jan;17(1):89-95. (PMID: 8682136)
Am J Emerg Med. 2012 Feb;30(2):267-74. (PMID: 21208763)
Isr J Psychiatry Relat Sci. 2008;45(1):49-54. (PMID: 18587169)
JAMA. 2000 Jul 5;284(1):79-84. (PMID: 10872017)
BMC Fam Pract. 2018 Jun 2;19(1):80. (PMID: 29859536)
Eur Heart J. 2012 Oct;33(20):2569-619. (PMID: 22922416)
Circulation. 2012 Oct 16;126(16):2020-35. (PMID: 22923432)
Heart. 2010 Jul;96(13):1001-10. (PMID: 20584855)
CMAJ. 2004 Jun 8;170(12):1803-7. (PMID: 15184334)
Eur J Gen Pract. 2015;21(3):156-63. (PMID: 25751665)
BMC Fam Pract. 2012 Aug 06;13:74. (PMID: 22866824)
Ann Emerg Med. 1999 Apr;33(4):437-47. (PMID: 10092723)
BMC Res Notes. 2015 Jun 03;8:210. (PMID: 26036786)
J Am Coll Cardiol. 2012 Dec 11;60(23):2427-63. (PMID: 23154053)
Heart. 2010 Jun;96(12):974-8. (PMID: 20538674)
فهرسة مساهمة: Keywords: acute coronary syndrome; biomarkers; chest pain; early diagnosis; point-of-care testing; primary health care
تواريخ الأحداث: Date Created: 20191004 Latest Revision: 20201001
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC6970583
DOI: 10.3399/bjgpopen19X101652
PMID: 31581111
قاعدة البيانات: MEDLINE
الوصف
تدمد:2398-3795
DOI:10.3399/bjgpopen19X101652