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Point-of-care testing of cardiac autonomic function for risk assessment in patients with suspected acute coronary syndromes

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Abstract

Background

Impaired cardiac autonomic function has been linked to adverse outcomes in patients with acute coronary syndromes (ACS) but is not included in clinical risk models. This is the first study to investigate whether point-of-care testing of cardiac autonomic function by means of short-term deceleration capacity (DC) of heart rate improves risk assessment in patients with suspected ACS.

Methods

1821 patients with suspected ACS were prospectively enrolled if they were older than 17 years and in sinus rhythm. Short-term DC was automatically assessed from monitor recordings at hospital admission. The Global Registry of Acute Coronary Events (GRACE) score was used as gold standard risk predictor. Primary endpoint was the composite of intrahospital and 30-day mortality. Secondary endpoint was 180-day mortality.

Results

Of the 1,821 patients with suspected ACS, 28 (1.5%) and 60 (3.3%) reached the primary and secondary endpoints, respectively. DC was a highly significant predictor of both endpoints, yielding areas under the curve (AUC) of 0.784 (95% CI 0.714–0.854) and 0.781 (0.727–0.832) (p < 0.001 for both), respectively. Implementing DC into the GRACE-risk model leads to a significant increase of the C-statistics from 0.788 (0.703–0.874) to 0.825 (0.750–0.900; p < 0.01 for difference) and from 0.814 (0.759–0.864) to 0.851 (0.808–0.889; p < 0.01 for difference) for the primary and secondary endpoints, respectively. Stratification by dichotomized DC was especially powerful in patients with GRACE score <140.

Conclusions

In patients with suspected ACS, point-of-care testing of cardiac autonomic function by means of DC is feasible and improves risk assessment by the GRACE score.

Clinical Trial Registration

Clinicaltrials.gov NCT01486589.

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Author notes

    Authors and Affiliations

    1. Medizinische Klinik III, Eberhard-Karls-Universität Tübingen, Tübingen, Germany

      C. Eick, M. Duckheim, P. Groga-Bada, N. Klumpp, S. Mannes, C. S. Zuern & M. Gawaz

    2. Medizinische Klinik und Poliklinik I, Munich University Clinic, Marchioninistr. 15, 81377, Munich, Germany

      K. D. Rizas & Axel Bauer

    3. German Center for Cardiovascular Research (DZHK), Munich, Germany

      K. D. Rizas & Axel Bauer

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    1. C. Eick
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    Correspondence to Axel Bauer.

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    K. D. Rizas and A. Bauer contributed equally to this work.

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    Eick, C., Duckheim, M., Groga-Bada, P. et al. Point-of-care testing of cardiac autonomic function for risk assessment in patients with suspected acute coronary syndromes. Clin Res Cardiol 106, 686–694 (2017). https://doi.org/10.1007/s00392-017-1104-3

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    • DOI: https://doi.org/10.1007/s00392-017-1104-3

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