• Mikiko Ohno, Hiroki Shiomi, Osamu Baba, Mariko Yano, Takanori Aizawa, Yukiko Nakano-Matsumura, Shintaro Yamagami, Masashi Kato, Masanobu Ohya, Po-Min Chen, Kazuya Nagao, Kenji Ando, Takafumi Yokomatsu, Kazushige Kadota, Ichiro Kouchi, Tsukasa Inada, Cindy Valentine, Takahiro Kitagawa, Masato Kurokawa, Shigeru Ohtsuru, Takeshi Morimoto, Takeshi Kimura, and Eiichiro Nishi.
• Department of Pharmacology, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan. moono@belle.shiga-med.ac.jp.
• Intern Emerg Med. 2024 Apr 1; 19 (3): 649659649-659.

AbstractAcute coronary syndrome (ACS) includes myocardial infarction (MI) and unstable angina (UA). MI is defined by elevated necrosis markers, preferably high-sensitivity cardiac troponins (hs-cTn). However, it takes hours for cTn to become elevated after coronary occlusion; therefore, difficulties are associated with diagnosing early post-onset MI or UA. The aim of this prospective cohort study was to examine the diagnostic ability of serum nardilysin (NRDC) for the early detection of ACS. This study consisted of two sequential cohorts, the Phase I cohort, 435 patients presenting to the emergency room (ER) with chest pain, and the Phase II cohort, 486 patients with chest pain who underwent coronary angiography. The final diagnosis was ACS in 155 out of 435 patients (35.6%) in the phase I and 418 out of 486 (86.0%) in the phase II cohort. Among 680 patients who presented within 24 h of onset, 466 patients (68.5%) were diagnosed with ACS. Serum NRDC levels were significantly higher in patients with ACS than in those without ACS. The sensitivity of NRDC in patients who presented within 6 h after the onset was higher than that of hsTnI, and the AUC of NRDC within 1 h of the onset was higher than that of hsTnI (0.718 versus 0.633). Among hsTnI-negative patients (300 of 680 patients: 44.1%), 136 of whom (45.3%) were diagnosed with ACS, the sensitivity and the NPV of NRDC were 73.5 and 65.7%, respectively. When measured in combination with hsTnI, NRDC plays auxiliary roles in the early diagnosis of ACS.© 2024. The Author(s).

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