Improving Cardiac Risk Stratification in Acute Syncope

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Natriuretic peptides and high-sensitive troponin may be useful for cardiac risk stratification in acute syncope.
Natriuretic peptides and high-sensitive troponin may be useful for cardiac risk stratification in acute syncope.

Natriuretic peptides and high-sensitive troponin may be useful for cardiac risk stratification in acute syncope, according to the results of a recent clinical synopsis published in the journal Annals of Emergency Medicine.

The MEDLINE, EMBASE, Cochrane Central Registrar of Controlled Trials, and the Database of Abstracts and Reviews of Effects databases were searched for randomized controlled trials, prospective, or retrospective studies among adult patients with acute syncope, using cardiac biomarkers for risk stratification to predict the outcome of major adverse cardiac events.

Outcomes assessed were the incidence of major adverse cardiac events, myocardial infarction, the diagnosis of cardiogenic syncope, and mortality within 30 days.

Among the 1,595 initial studies identified, 104 met inclusion criteria and underwent further selection review. Ultimately, 11 studies were included in the analysis, 4 of which used contemporary troponin, 4 used brain-type natriuretic peptides, and 3 used high-sensitivity troponins.

Contemporary troponin, brain type natriuretic peptides, and high-sensitivity troponin had specificities of 87%, 69%, and 62% respectively, for myocardial infarction. Furthermore, contemporary troponins had higher specificity than brain type natriuretic peptides and high-sensitivity troponin for 30-day mortality predictions.

However, brain-type natriuretic peptides and high-sensitivity troponin had higher sensitivities than contemporary troponin studies to detect major adverse cardiac events and mortality.

The study authors wrote, “Although cardiac biomarker values may provide incremental increases in an emergency clinician's ability to risk stratify syncope patients, brain-type natriuretic peptides appear to be the most promising”.

They added, “The incorporation of brain-type natriuretic peptides or high-sensitivity troponins to future clinical decision rules may help identify patients at low risk of adverse cardiac events”.

Reference

West JR, Russell J. What is the diagnostic accuracy of cardiac biomarkers for the prediction of adverse cardiac events in patients presenting with acute syncope? [published online August 27, 2018]. Ann Emerg Med. doi: 10.1016/j.annemergmed.2018.06.047

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