The following article is a part of conference coverage from the American Heart Association Scientific Sessions 2021, being held virtually from November 13 to 15, 2021. The team at Cardiology Advisor will be reporting on the latest news and research conducted by leading experts in cardiology. Check back for more from the AHA Scientific Sessions 2021.
Nardilysin is a potential biomarker for the early diagnosis of non-ST-segment elevation acute coronary syndrome (ACS) especially in patients who are negative for high-sensitivity cardiac troponin, according to study results presented at AHA 2021, held from November 13 to 15, 2021.
Investigators of this multicenter prospective study sought to elucidate the role of nardilysin as a diagnostic biomarker associated with onset of non-ST-segment elevation ACS. A total of 435 patients who consecutively visited the ER with chest pain were included in a primary phase I cohort; 486 patients with suspected ACS and who previously underwent coronary angiography participated in a validation phase II cohort. Investigators analyzed serum nardilysin and high-sensitivity cardiac troponin levels in both cohorts with cutoffs set at 1350.9 pg/ml (mean +2SD) and 52 pg/ml, respectively.
In the phase I cohort, 64.4% of patients were diagnosed as non-ACS, 22.5% with ST-segment elevation myocardial infarction (STEMI), and 13.1% with non-ST-segment elevation ACS. In the phase II cohort, 14% of patients were diagnosed as non-ACS, 60% with STEMI, and 25.9% with non-ST-segment elevation ACS. In phase I analyses, nardilysin was significantly elevated in patients with ACS vs non-ACS (P <.05). For the diagnosis of non-ST-segment elevation ACS, sensitivity of troponin as a biomarker was 52.6%, nardilysin was 57.9%, and nardilysin combined with troponin was 78.9%. The negative predictive value of troponin was 90.7%, nardilysin was 88.7%, and nardilysin combined with troponin was 92.4%.
In patients negative for high-sensitivity cardiac troponin, the sensitivity of nardilysin to detect early STEMI and non-ST-segment elevation ACS was 64.7% and 91.4%, respectively, and the negative predictive value of nardilysin was 55.6% and 91.4%, respectively. In patients whose blood was examined within 3 hours of onset, nardilysin was more sensitive than high-sensitivity cardiac troponin to detect STEMI (77.6% vs 51.2%) and non-ST-segment elevation ACS (60.4% vs 56.3%).
Researchers indicated that, for early diagnosis of non-ST-segment elevation ACS in troponin-negative patients, serum nardilysin is a potential biomarker and was especially sensitive shortly after onset.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Ohno M, Shiomi H, Yano M, et al. Nardilysin is a potential biomarker for the early diagnosis of non-ST-segment elevation acute coronary syndrome, a multicenter prospective cohort study, Nardi-ACS Study. Presented at: AHA 2021; November 13-15, 2021. Poster P95.
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