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Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction

Boeddinghaus, Jasper (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;Univ Basel, Div Internal Med, Univ Hosp Basel, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy
Nestelberger, Thomas (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy
Twerenbold, Raphael (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy;Hamburg Univ Heart Ctr, Dept Gen & Intervent Cardiol, Martinistr 52, D-20246 Hamburg, Germany
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Neumann, Johannes Tobias (författare)
Hamburg Univ Heart Ctr, Dept Gen & Intervent Cardiol, Martinistr 52, D-20246 Hamburg, Germany
Lindahl, Berta (författare)
Uppsala universitet,Institutionen för medicinska vetenskaper,Uppsala kliniska forskningscentrum (UCR)
Giannitsis, Evangelos (författare)
Heidelberg Univ, Med Klin 3, Neuenheimer Feld 410, D-69120 Heidelberg, Germany
Soerensen, Nils Arne (författare)
Hamburg Univ Heart Ctr, Dept Gen & Intervent Cardiol, Martinistr 52, D-20246 Hamburg, Germany
Badertscher, Patrick (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy
Jann, Janina E. (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy
Wussler, Desiree (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy
Puelacher, Christian (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy
Gimenez, Maria Rubini (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy
Wildi, Karin (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy
Strebel, Ivo (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy
de Lavallaz, Jeanne Du Fay (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy
Selman, Farah (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland
Sabti, Zaid (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy
Kozhuharov, Nikola (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy
Potlukova, Eliska (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;Univ Basel, Div Internal Med, Univ Hosp Basel, Petersgraben 4, CH-4031 Basel, Switzerland
Rentsch, Katharina (författare)
Univ Basel, Lab Med, Univ Hosp Basel, Petersgraben 4, CH-4031 Basel, Switzerland
Miro, Oscar (författare)
3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy;Hosp Clin Barcelona, Emergency Dept, Calle Villarroel 170, Barcelona 08036, Catalonia, Spain
Martin-Sanchez, F. Javier (författare)
3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy;Hosp Clin San Carlos, Serv Urgencias, Prof Martin Lagos S-N, Madrid 28040, Spain
Morawiec, Beata (författare)
3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy;Med Univ Katowice, Div Dent Zabrze, Dept Cardiol 2, Sch Med, Ul M Curie Sklodowskiej 9, PL-41800 Zabrze, Poland
Parenica, Jiri (författare)
3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy;Univ Hosp Brno, Dept Cardiol, Jihlavska 20, CZ-62500 Brno, Czech Republic;Masaryk Univ, Med Fac, Kamenice 5, Brno 62500, Czech Republic
Lohrmann, Jens (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland
Kloos, Wanda (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland
Buser, Andreas (författare)
Swiss Red Cross, Blood Transfus Ctr, Hebelstr 10, CH-4056 Basel, Switzerland;Univ Basel, Univ Hosp Basel, Dept Hematol, Petersgraben 4, CH-4031 Basel, Switzerland
Geigy, Nicolas (författare)
Kantonsspital Liestal, Emergency Dept, Rheinstr 26, CH-4410 Liestal, Switzerland
Keller, Dagmar, I (författare)
Univ Hosp Zurich, Emergency Dept, Ramistr 100, CH-8091 Zurich, Switzerland
Osswald, Stefan (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland
Reichlin, Tobias (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy
Westermann, Dirk (författare)
Hamburg Univ Heart Ctr, Dept Gen & Intervent Cardiol, Martinistr 52, D-20246 Hamburg, Germany
Blankenberg, Stefan (författare)
Hamburg Univ Heart Ctr, Dept Gen & Intervent Cardiol, Martinistr 52, D-20246 Hamburg, Germany
Mueller, Christian (författare)
Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy
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 (creator_code:org_t)
2018-08-29
2018
Engelska.
Ingår i: European Heart Journal. - : OXFORD UNIV PRESS. - 0195-668X .- 1522-9645. ; 39:42, s. 3780-3794
Relaterad länk:
https://academic.oup...
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https://urn.kb.se/re...
https://doi.org/10.1...
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  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
Stäng  
  • Aims We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1h-algorithms and to derive and externally validate alternative cut-offs specific to older patients. Methods and results We prospectively enrolled patients presenting to the emergency department (ED) with symptoms suggestive of and results acute myocardial infarction in three large diagnostic studies. Final diagnoses were adjudicated by two independent cardiologists. High-sensitivity cardiac troponin (hs-cTn) T and I concentrations were measured at presentation and after 1 h. Patients were stratified according to age [<55 years (young), >= 55 to <70 years (middle-age), >= 70 years (old)]. Rule-out safety of the ESC hs-cTnT 0/1h-algorithm was very high in all age-strata: sensitivity 100% [95% confidence interval (95% CI) 94.9-100] in young, 99.3% (95% CI 96.0-99.9) in middle-age, and 99.3% (95% CI 97.599.8) in old patients. Accuracy of rule-in decreased with age: specificity 97.0% (95% CI 95.8-97.9) in young, 96.1% (95% CI 94.5-97.2) in middle-age, and 92.7% (95% CI 90.7-94.3) in older patients. Triage efficacy decreased with increasing age (young 93%, middle-age 80%, old 55%, P <0.001). Similar results were found for the ESC hs-cTnT 0/1h-algorithm. Alternative, slightly higher cut-off concentrations optimized for older patients maintained very high safety of rule-out, increased specificity of rule-in (P< 0.01), reduced overall efficacy for hs-cTnT (P <0.01), while maintaining efficacy for hs-cTnl. Findings were confirmed in two validation cohorts (n = 2767). Conclusion While safety of the ESC 0/1h-algorithms remained very high, increasing age significantly reduced overall efficacy and the accuracy of rule-in. Alternative slightly higher cut-off concentrations may be considered for older patients, particularly if using hs-cTnl.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

Age
High-sensitivity cardiac troponin
Guidelines
0/1h-Algorithm
Diagnosis of AMI

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