دورية أكاديمية
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.
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. |
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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.) |
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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 |
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