利用生物标志物患者急性心血管疾病课件.ppt

Use of Biomarkers in Patients with Acute Cardiovascular Disease ECG Risk Factors in Patients with ACS Relationship of ECG Changes and FPA* Long-Term Prognostic Value of ElevatedcTnI in Unstable Angina Individual Studies of Patients with“Unstable Angina” Without ST Segment Elevation Individual Studies of Patients with “Unstable Angina” and Normal CKMB Values cTnI in Patients with Unstable Angina Synergism of ECG and Elevated Troponins (PARAGON) FRISC-II – GUSTO IV (Death and MI) Correspondence Between Commercial Assays and Western Blotting MyeloperoxidasePredictions of Events When cTNT “Negative” cTnI Negative ACS? Sensitivity of cTnI, CK-MB, and Myoglobin with Sensitive Contemporary Assays cTnT and Angiographic Measures Medical and Interventional Response to GP IIb/IIIa Agents in Troponin Positive Patients LMW Heparin vs VF Heparin in TIMI 11B TACTICS (TIMI 18) Relation Between Creatinine Clearance,Troponin T, and Outcomes CURERates and Relative Risks of First Primary Outcome BNP Levels in Heart Failure Beta-Blocker Therapy and BNP Levels Outcomes by Number of Positive OutcomesTACTICS-TIMI 18 Odds of Positive MarkerTACTICS-TIMI 18 CP1189452-27 ED Probability of CHF Recorded P0.0001 from clinical judgment to combined McCullough PA et al: Circulation 106:416, 2002 Diagnostic accuracy (%) Clinicaljudgment BNP Combined 70 72 74 76 78 80 82 74.0 81.2 81.5 n=1,538 BNP Study Primary End Point n=1,586; ?50% CHF; 56% male;64±17 yo; 41% COPD; ?30% Hx CHF CP1189452-28 BNP(pg/mL) Sens Spec PPV NPV 50 97 62 71 95 100 90 76 79 89 150 85 83 83 85 AUC = 0.91 Breathing Not Proper (BNP)Multicenter Trial AJC 95, April 15, 2005 Optimal cut-point Sens Spec PPV NPV Accuracy (%) (%) (%) (%) (%) (%) Rule-in cutpoints All pt (n=599) 900 90 85 76 94 87 50 yr old 450 93 95 67 99 95 n=144 ?50 yr old 900 91 80 77 92 85 n=455 Rule-out pt All pt (n=599) 300 99 68 62 99 83 CP1189452-30 Optimal NT-proBNP Cutpoints for Acute Congestive Heart Failure McCullough