{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:41:41Z","timestamp":1777448501830,"version":"3.51.4"},"reference-count":24,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["Previous funding for testing via CIHR grants to PK"],"award-info":[{"award-number":["Previous funding for testing via CIHR grants to PK"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Guidelines published in 2021 have supported natriuretic peptide (NP) testing for the prognostication in patients with acute coronary syndrome (ACS) and for the diagnosis of chronic and acute heart failure (HF). Our objective was to determine if the addition of N-terminal pro B-type NP (NT-proBNP) and glucose to high-sensitivity cardiac troponin (hs-cTn) could better identify emergency department (ED) patients with potential ACS at low- and high-risk for a serious cardiovascular outcome over the next 72 h. The presentation sample in two different ED cohorts which enrolled patients with symptoms suggestive of ACS within six hours of pain onset (Cohort-1, n = 126 and Cohort-2, n = 143) that had Abbott hs-cTnI, Roche hs-cTnT, NT-proBNP and glucose were evaluated for NT-proBNP alone and combined with hs-cTn and glucose for the primary outcome (composite which included death, myocardial infarction, HF, serious arrhythmia and refractory angina) via receiver-operating characteristic (ROC) curve analyses with area under the curve (AUC) and diagnostic estimates derived. The AUC for NT-proBNP for the primary outcome was 0.68 (95% confidence interval (CI): 0.59\u20130.76) and 0.75 (95%CI: 0.67\u20130.82) in Cohort-1 and 2, respectively, with the 125 ng\/L cutoff yielding a higher sensitivity (\u226575%) as compared to the 300 ng\/L cutoff (\u226558%). Using the 125 ng\/L cutoff for NT-proBNP with the published glucose and hs-cTn cutoffs for risk-stratification produced a new score (GuIDER score for Glucose, Injury and Dysfunction in the Emergency-setting for cardiovascular-Risk) and yielded higher AUCs as compared to NT-proBNP (p &lt; 0.05). GuIDER scores of 0 and 5 using either hs-cTnI\/T yielded sensitivity estimates of 100% and specificity estimates &gt; 92% for the primary outcome. A secondary analysis assessing MI alone in the overall population (combined Cohorts 1 and 2) also achieved 100% sensitivity for MI with a GuIDER cutoff \u2265 2, ruling-out 48% (Roche) and 38% (Abbott) of the population at presentation for MI. Additional studies are needed for the GuIDER score in both the acute and ambulatory setting to further refine the utility, however, the preliminary findings reported here may present a pathway forward for inclusion of NP testing for ruling-out serious cardiac events and MI in the emergency setting.<\/jats:p>","DOI":"10.3390\/jcdd8090106","type":"journal-article","created":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T11:39:03Z","timestamp":1630496343000},"page":"106","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Can the Addition of NT-proBNP and Glucose Measurements Improve the Prognostication of High-Sensitivity Cardiac Troponin Measurements for Patients with Suspected Acute Coronary Syndrome?"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4576-4744","authenticated-orcid":false,"given":"Peter A.","family":"Kavsak","sequence":"first","affiliation":[{"name":"Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shawn E.","family":"Mondoux","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark K.","family":"Hewitt","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig","family":"Ainsworth","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, McMaster University, Hamilton, ON L8S 4L8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Worster","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1093\/eurheartj\/ehaa575","article-title":"2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation","volume":"42","author":"Collet","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_2","first-page":"352","article-title":"Universal definition and classification of heart failure: A report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure","volume":"23","author":"Bozkurt","year":"2021","journal-title":"J. Card. Fail."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2370","DOI":"10.1161\/CIRCULATIONAHA.120.053134","article-title":"Development and Validation of Machine Learning-Based Race-Specific Models to Predict 10-Year Risk of Heart Failure: A Multi-Cohort Analysis","volume":"143","author":"Segar","year":"2021","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"E974","DOI":"10.1503\/cmaj.180144","article-title":"Clinical chemistry score versus high-sensitivity cardiac troponin I and T tests alone to identify patients at low or high risk for myocardial infarction or death at presentation to the emergency department","volume":"190","author":"Kavsak","year":"2018","journal-title":"Can. Med. Assoc. J."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kavsak, P.A., Cerasuolo, J.O., Mondoux, S.E., Sherbino, J., Ma, J., Hoard, B.K., Perez, R., Seow, H., Ko, D.T., and Worster, A. (2020). Risk Stratification for Patients with Chest Pain Discharged Home from the Emergency Department. J. Clin. Med., 9.","DOI":"10.3390\/jcm9092948"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"E676","DOI":"10.9778\/cmajo.20200047","article-title":"Using the clinical chemistry score in the emergency department to detect adverse cardiac events: A diagnostic accuracy study","volume":"8","author":"Kavsak","year":"2020","journal-title":"CMAJ Open"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.clinbiochem.2021.02.006","article-title":"External validation of the clinical chemistry score","volume":"91","author":"Wildi","year":"2021","journal-title":"Clin. Biochem."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.clinbiochem.2021.06.002","article-title":"Clinical chemistry score misses fewer deaths as compared to troponin T alone in a United States emergency department population","volume":"95","author":"Liu","year":"2021","journal-title":"Clin. Biochem."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.clinbiochem.2012.10.003","article-title":"Predicting myocardial infarction and other serious cardiac outcomes using high-sensitivity cardiac troponin T in a high-risk stable population","volume":"46","author":"McQueen","year":"2013","journal-title":"Clin. Biochem."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1016\/j.jacc.2012.12.026","article-title":"Prognostic value of cardiac troponin I measured with a highly sensitive assay in patients with stable coronary artery disease","volume":"61","author":"Omland","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1161\/CIRCULATIONAHA.114.010815","article-title":"Diabetes, Pre-Diabetes and Incidence of Subclinical Myocardial Damage","volume":"130","author":"Selvin","year":"2014","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1373\/clinchem.2017.277186","article-title":"Clinical Laboratory Practice Recommendations for the Use of Cardiac Troponin in Acute Coronary Syndrome: Expert Opinion from the Academy of the American Association for Clinical Chemistry and the Task Force on Clinical Applications of Cardiac Bio-Markers of the International Federation of Clinical Chemistry and Laboratory Medicine","volume":"64","author":"Wu","year":"2018","journal-title":"Clin. Chem."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.clinbiochem.2015.01.008","article-title":"High-sensitive cardiac troponin, NT-proBNP, hFABP and copeptin levels in relation to glomerular filtration rates and a medical record of cardiovascular disease","volume":"48","author":"Bjurman","year":"2015","journal-title":"Clin. Biochem."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1373\/clinchem.2011.172064","article-title":"Biomarkers for Predicting Serious Cardiac Outcomes at 72 Hours in Patients Presenting Early after Chest Pain Onset with Symptoms of Acute Coronary Syndromes","volume":"58","author":"Kavsak","year":"2012","journal-title":"Clin. Chem."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1373\/clinchem.2013.208595","article-title":"Ninety-Minute vs 3-h Performance of High-Sensitivity Cardiac Troponin Assays for Predicting Hospitalization for Acute Coronary Syndrome","volume":"59","author":"Kavsak","year":"2013","journal-title":"Clin. Chem."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1503\/cmaj.045194","article-title":"Capability of ischemia-modified albumin to predict serious cardiac outcomes in the short term among patients with potential acute coronary syndrome","volume":"172","author":"Worster","year":"2005","journal-title":"Can. Med. Assoc. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1161\/CIRCULATIONAHA.116.022677","article-title":"Assessment of the European Society of Cardiology 0-Hour\/1-Hour Algorithm to Rule-Out and Rule-In Acute Myocardial Infarction","volume":"134","author":"Pickering","year":"2016","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.clinbiochem.2014.11.010","article-title":"An approach to rule-out an acute cardiovascular event or death in emergency department patients using outcome-based cutoffs for high-sensitivity cardiac troponin assays and glucose","volume":"48","author":"Shortt","year":"2015","journal-title":"Clin. Biochem."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/S0196-0644(98)70352-X","article-title":"Clinical utility of likelihood ratios","volume":"31","author":"Gallagher","year":"1998","journal-title":"Ann. Emerg. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the Areas under Two or More Correlated Receiver Operating Characteristic Curves: A Nonparametric Approach","volume":"44","author":"Delong","year":"1988","journal-title":"Biometrics"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.cca.2017.03.021","article-title":"A laboratory score at presentation to rule-out serious cardiac outcomes or death in patients presenting with symptoms suggestive of acute coronary syndrome","volume":"469","author":"Kavsak","year":"2017","journal-title":"Clin. Chim. Acta"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1373\/jalm.2019.029512","article-title":"A Multicenter Assessment of the Sensitivity and Specificity for a Single High-Sensitivity Cardiac Troponin Test at Emergency Department Presentation for Hospital Admission","volume":"4","author":"Kavsak","year":"2019","journal-title":"J. Appl. Lab. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2529","DOI":"10.1056\/NEJMoa1803377","article-title":"Application of High-Sensitivity Troponin in Suspected Myocardial Infarction","volume":"380","author":"Neumann","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kavsak, P.A., Hewitt, M.K., Mondoux, S.E., Cerasuolo, J.O., Ma, J., Clayton, N., McQueen, M., Griffith, L.E., Perez, R., and Seow, H. (2021). Diagnostic Performance of Serial High-Sensitivity Cardiac Troponin Measurements in the Emergency Setting. J. Cardiovasc. Dev. 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