Key result
Adding the cardiac electrical biomarker to conventional ECG criteria improved the diagnostic accuracy for NSTEMI, increasing the AUC from 0.66 to 0.71 (p < .001) and sensitivity from 43% to 79%.
Why the study?
Does the cardiac electrical biomarker (CEB) improve diagnostic accuracy for NSTEMI in patients presenting to the emergency department with suspected NSTEMI?
Observational (n=1,097)
Blinded
Does the cardiac electrical biomarker (CEB) improve diagnostic accuracy for NSTEMI in patients presenting to the emergency department with suspected NSTEMI?
Answers are grounded in this paper and cite their sources.
The novel cardiac electrical biomarker (CEB) significantly improves the diagnostic accuracy and sensitivity of standard ECG for detecting NSTEMI in emergency department patients.
BACKGROUND: The cardiac electrical biomarker (CEB) is a novel electrocardiographic (ECG) marker quantifying the dipolar activity of the heart with higher levels indicating myocardial injury. METHODS: We prospectively enrolled 1097 patients presenting with suspected non-ST-elevation myocardial infarction (NSTEMI) to the emergency department (ED). Digital 12-lead ECGs were recorded at presentation and the CEB values were calculated in a blinded fashion. The final diagnosis was adjudicated by two independent cardiologists. The prognostic endpoint was all-cause mortality during 2 years of follow-up. RESULTS: NSTEMI was the final diagnosis in 14% of patients. CEB levels were higher in patients with NSTEMI compared to other causes of chest pain (median 44 (IQR 21-98) vs. 30 (IQR 16-61), p < .001). A weak but significant correlation between levels of high-sensitivity cardiac troponin T (hs-cTnT) at admission to the ED and the CEB was found (r = .23, p < .001). The use of the CEB in addition to conventional ECG criteria improved the diagnostic accuracy for the diagnosis of NSTEMI as quantified by the area under the receiver operating characteristics curve from 0.66 to 0.71 (p < .001) and the sensitivity improved from 43% to 79% (p < .001). CONCLUSION: In conclusion, the CEB, an ECG marker of myocardial injury, significantly improves the accuracy and sensitivity of the ECG for the diagnosis of NSTEMI.
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Strebel et al. (2018) conducted an observational in Suspected non-ST-elevation myocardial infarction (NSTEMI) (n=1,097). Cardiac electrical biomarker (CEB) vs. Conventional ECG criteria was evaluated on Diagnostic accuracy for NSTEMI (Area under the receiver operating characteristics curve) (p=<.001). Adding the cardiac electrical biomarker to conventional ECG criteria improved the diagnostic accuracy for NSTEMI, increasing the AUC from 0.66 to 0.71 (p < .001) and sensitivity from 43% to 79%.
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