The combined point-of-care testing model using NT-proBNP, D-dimer, and hs-CRP predicted in-hospital MACE with an AUC of 0.958, significantly outperforming the GRACE risk score (AUC 0.822) in patients aged ≥60 years with NSTE-ACS.
Cohort (n=117)
No
Does a combined point-of-care testing model using NT-proBNP, D-dimer, and hs-CRP improve early prediction of in-hospital MACE prior to revascularization compared to the GRACE risk score in elderly patients with NSTE-ACS?
A combined point-of-care testing model using NT-proBNP, D-dimer, and hs-CRP provides superior early risk stratification for in-hospital MACE in elderly NSTE-ACS patients compared to the standard GRACE risk score.
Effect estimate: AUC 0.958 for CM-POCT model vs. AUC 0.822 for GRACE risk score (95% CI 95% CI 0.923–0.993 for CM-POCT; 0.730–0.913 for GRACE)
p-value: p=0.003
Background Risk stratification is crucial for patients aged ≥60 years with non-ST-elevation acute coronary syndrome (NSTE-ACS). Although the Global Registry of Acute Coronary Events (GRACE) risk score is commonly used, it may be less practical in the emergency setting. This study aimed to evaluate whether a combined point-of-care testing (CM-POCT) model using three biomarkers could effectively predict major adverse cardiovascular events (MACE). Methods This retrospective study included 117 patients aged ≥60 years with NSTE-ACS presenting to the emergency department. Point-of-care testing for NT-proBNP, D-dimer, and hs-CRP was performed within 6 h of symptom onset. Independent risk factors were identified, and the predictive value of the three-marker CM-POCT model was compared with the GRACE risk score using receiver operating characteristic curve analysis. Results Among the 117 participants (mean age 72.2 ± 8.0 years), 27 experienced MACE. Elevated levels of NT-proBNP (≥2,410 pg/mL), D-dimer (≥0.54 µg/mL), and hs-CRP (≥5.58 µg/mL) were each independent predictors of MACE (all P 0.05). The incidence of MACE increased progressively with the number of elevated markers from 0.0% (no positive markers) to 3.45% (one positive marker), 40.0% (two positive markers), and 86.96% (three positive markers). The area under the curve (AUC) of the three-marker CM-POCT model was 0.958 (95% CI: 0.923–0.993), significantly higher than the GRACE risk score (AUC: 0.822; 95% CI: 0.730–0.913; P = 0.003). Conclusions The three-marker CM-POCT model could be a more efficient tool for early risk stratification in patients aged ≥60 years with NSTE-ACS in emergency settings. The risk of MACE increases significantly with the number of positive markers.
Yan et al. (Thu,) conducted a cohort in Patients aged ≥60 years with non-ST-elevation acute coronary syndrome (including unstable angina and NSTEMI) presenting to the emergency department (n=117). Combined point-of-care testing (CM-POCT) model using NT-proBNP, D-dimer, and hs-CRP biomarkers vs. GRACE risk score was evaluated on In-hospital major adverse cardiovascular events (MACE) prior to revascularisation (including recurrent chest pain unresponsive to medication, haemodynamic instability/cardiogenic shock, life-threatening arrhythmia, acute heart failure, dynamic ECG ST-T changes) (AUC 0.958 for CM-POCT model vs. AUC 0.822 for GRACE risk score, 95% CI 95% CI 0.923–0.993 for CM-POCT; 0.730–0.913 for GRACE, p=0.003). The combined point-of-care testing model using NT-proBNP, D-dimer, and hs-CRP predicted in-hospital MACE with an AUC of 0.958, significantly outperforming the GRACE risk score (AUC 0.822) in patients aged ≥60 years with NSTE-ACS.