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  • Bima, PaoloUniv Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland.;GREAT Network, Rome, Italy.;Univ Torino, Dept Med Sci, Turin, Italy. (författare)

Chest Pain in Cancer Patients Prevalence of Myocardial Infarction and Performance of High-Sensitivity Cardiac Troponins

  • Artikel/kapitelEngelska2023

Förlag, utgivningsår, omfång ...

  • Elsevier,2023
  • electronicrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:uu-517517
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-517517URI
  • https://doi.org/10.1016/j.jaccao.2023.08.001DOI

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  • Språk:engelska
  • Sammanfattning på:engelska

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Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • BACKGROUND Little is known about patients with cancer presenting with acute chest discomfort to the emergency department (ED).OBJECTIVES The aim of this study was to assess the prevalence of acute myocardial infarction (AMI), outcomes, and the diagnostic utility of recommended diagnostic tools in this population.METHODS Patients presenting with chest pain to the ED were prospectively enrolled in an international multicenter diagnostic study with central adjudication. Cancer status was assessed prospectively and additional cancer details retrospectively. Findings were externally validated in an independent multicenter cohort.RESULTS Among 8,267 patients, 711 (8.6%) had cancer. Patients with cancer had a higher burden of cardiovascular risk factors and pre-existing cardiac disease. Total length of stay in the ED (5.2 hours vs 4.3 hours) and hospitalization rate (49.8% vs 34.3%) were both increased in patients with cancer (P < 0.001 for both). Among 8,093 patients eligible for the AMI analyses, those with cancer more often had final diagnoses of AMI (184 of 686 with cancer [26.8%] vs 1,561 of 7,407 without cancer [21.1%]; P < 0.001). In patients with cancer, high-sensitivity cardiac troponin T (hs-cTnT) but not high sensitivity cardiac troponin I (hs-cTnI) concentration had lower diagnostic accuracy for non-ST-segment elevation myocardial infarction (for hs-cTnT, area under the curve: 0.89 [95% CI: 0.86-0.92] vs 0.94 [95% CI: 0.93-0.94] [P < 0.001]; for hs-cTnI, area under the curve: 0.93 [95% CI: 0.91-0.95] vs 0.95 [95% CI: 0.94-0.95] [P 1/4 0.10]). In patients with cancer, the European Society of Cardiology 0/1-hour hs-cTnT and hs-cTnI algorithms maintained very high safety but had lower efficacy, with twice the number of patients remaining in the observe zone. Similar findings were obtained in the external validation cohort.CONCLUSIONS Patients with cancer have a substantially higher prevalence of AMI as the cause of chest pain. Length of ED stay and hospitalization rates are increased. The diagnostic performance of hs-cTnT and the efficacy of both the European Society of Cardiology 0/1-hour hs-cTnT and hs-cTnI algorithms is reduced. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study; NCT00470587) (J Am Coll Cardiol CardioOnc 2023;5:591-609) (c) 2023 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Lopez-Ayala, PedroUniv Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland.;GREAT Network, Rome, Italy. (författare)
  • Koechlin, LucaUniv Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland.;GREAT Network, Rome, Italy.;Univ Basel, Univ Hosp Basel, Dept Cardiac Surg, Basel, Switzerland. (författare)
  • Boeddinghaus, JasperUniv Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland.;GREAT Network, Rome, Italy.;Univ Edinburgh, Univ Ctr Cardiovasc Sci, BHF, Edinburgh, Scotland. (författare)
  • Nestelberger, ThomasUniv Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland.;GREAT Network, Rome, Italy. (författare)
  • Okamura, BernhardUniv Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland.;GREAT Network, Rome, Italy. (författare)
  • Muench-Gerber, Tamar S.Univ Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland.;GREAT Network, Rome, Italy. (författare)
  • Sanzone, AlessandraUniv Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland.;GREAT Network, Rome, Italy. (författare)
  • Skolozubova, DariaUniv Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland. (författare)
  • Djurdjevic, DavidUniv Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland. (författare)
  • Gimenez, Maria RubiniUniv Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland.;Herzzentrum Leipzig, Cardiol Dept, Leipzig, Germany. (författare)
  • Wildi, KarinUniv Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland.;GREAT Network, Rome, Italy. (författare)
  • Miro, OscarHosp Clin Barcelona, Emergency Dept, Barcelona, Spain. (författare)
  • Martinez-Nadal, GemmaHosp Clin Barcelona, Emergency Dept, Barcelona, Spain. (författare)
  • Martin-Sanchez, Francisco J.Hosp Clin San Carlos, Emergency Dept, Madrid, Spain. (författare)
  • Christ, MichaelLuzerner Kantonsspital, Dept Emergency Med, Luzern, Switzerland. (författare)
  • Keller, DagmarUniv Hosp Zurich, Emergency Dept, Zurich, Switzerland. (författare)
  • Lindahl, Bertil,1957-Uppsala universitet,Institutionen för medicinska vetenskaper(Swepub:uu)belin227 (författare)
  • Giannitsis, EvangelosUniv Hosp Heidelberger, Dept Med 3, Heidelberg, Germany. (författare)
  • Mueller, ChristianUniv Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland.;GREAT Network, Rome, Italy.;Univ Hosp Basel, Cardiovasc Res Inst Basel, Petersgraben 4, CH-4031 Basel, Switzerland.;Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland. (författare)
  • Univ Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland.;GREAT Network, Rome, Italy.;Univ Torino, Dept Med Sci, Turin, Italy.Univ Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland.;GREAT Network, Rome, Italy. (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:JACC: CARDIOONCOLOGY: Elsevier5:5, s. 591-6092666-0873

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