The feasibility and diagnostic accuracy by multiple cardiac biomarkers in emergency chest pain patients: A clinical analysis to compare 290 suspected acute coronary syndrome cases stratified by age and gender in Taiwan

Abstract

Background: Accurate diagnosis of acute coronary syndrome (ACS) in a timely fashion is challenging in the elderly population, especially elderly women, who usually exhibit atypical clinical symptoms. A multiple cardiac biomarker (MCB) based approach has been shown to improve diagnostic efficacy of ACS. However, data in various age groups and sex differences remain largely unexplored. Methods: Point-of-care testing (POCT) was performed on 290 patients (aged ≥18 years) who were admitted to the emergency department (ED) with symptoms of acute chest pain under suspicion of acute coronary syndrome (ACS). The MCB approach in current work assessed four cardiac biomarkers: myoglobin, troponin I, creatine kinase-myocardial band isoenzyme fraction (CK-MB), and brain natriuretic peptide (BNP). Results: Overall, the MCB approach demonstrated considerably higher sensitivity for elderly patients than for younger patients in identifying ACS (80.0 % [64.1-90.0] vs. 52.6 % [37.3-67.5] for ≥65 years and <65 years groups), with younger population showed greater specificity (44.1 % [35.3-53.4] vs. 84.9 % [76.9-90.5] for ≥65 years and <65 years groups, respectively). The highest sensitivity achieved for elderly women who reported chest pain was 87.5 % [95 % CI: 64-96.5]). In general, the sensitivity of this approach was higher for female patients than for male patients (80 % [58.4-91.9] vs. 61 % [47.8-73.0]). Conclusions: The MCB approach can provide a quick and accurate clinical diagnosis in elderly and female patients, both of whom have traditionally proven to be challenging to diagnose from suspected acute coronary syndrome.