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  • Mueller, ChristianUniv Basel Hosp, Dept Cardiol, Basel, Switzerland.;Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland. (author)

Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T

  • Article/chapterEnglish2016

Publisher, publication year, extent ...

  • Elsevier BV,2016
  • electronicrdacarrier

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  • LIBRIS-ID:oai:DiVA.org:uu-300470
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-300470URI
  • https://doi.org/10.1016/j.annemergmed.2015.11.013DOI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:133885452URI

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  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • Study objective: We aim to prospectively validate the diagnostic accuracy of the recently developed 0-h/1-h algorithm, using high-sensitivity cardiac troponin T (hs-cTnT) for the early rule-out and rule-in of acute myocardial infarction. Methods: We enrolled patients presenting with suspected acute myocardial infarction and recent (<6 hours) onset of symptoms to the emergency department in a global multicenter diagnostic study. Hs-cTnT (Roche Diagnostics) and sensitive cardiac troponin I (Siemens Healthcare) were measured at presentation and after 1 hour, 2 hours, and 4 to 14 hours in a central laboratory. Patient triage according to the predefined hs-cTnT 0-hour/1-hour algorithm (hs-cTnT beloow 12 ng/L and Delta 1 hour below 3 ng/L to rule out; hs-cTnT at least 52 ng/L r Delta 1 hour at least 5 ng/L to rule in; remaining patients to the "observational zone") was compared against a centrally adjudicated final diagnosis by 2 independent cardiologists (reference standard). The final diagnosis was based on all available information, including coronary angiography and echocardiography results, follow-up data, and serial measurements of sensitive cardiac troponin I, whereas adjudicators remained blinded to hs-cTnT. Results: Among 1,282 patients enrolled, acute myocardial infarction was the final diagnosis for 213 (16.6%) patients. Applying the hs-cTnT 0-hour/1-hour algorithm, 813 (63.4%) patients were classified as rule out, 184 (14.4%) were classified as rule in, and 285 (22.2%) were triaged to the observational zone. This resulted in a negative predictive value and sensitivity for acute myocardial infarction of 99.1% (95% confidence interval [CI] 98.2% to 99.7%) and 96.7% (95% CI 93.4% to 98.7%) in the rule-out zone (7 patients with false-negative results), a positive predictive value and specificity for acute myocardial infarction of 77.2% (95% CI 70.4% to 83.0%) and 96.1% (95% CI 94.7% to 97.2%) in the rule-in zone, and a prevalence of acute myocardial infarction of 22.5% in the observational zone. Conclusion: The hs-cTnT 0-hour/1-hour algorithm performs well for early rule-out and rule-in of acute myocardial infarction.

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Added entries (persons, corporate bodies, meetings, titles ...)

  • Giannitsis, EvangelosUniv Heidelberg Hosp, Heidelberg, Germany. (author)
  • Christ, MichaelParacelsus Med Univ, Gen Hosp, Dept Emergency & Crit Care Med, Nurnberg, Germany. (author)
  • Ordonez-Llanos, JorgeInst Invest Biomed St Pau, Dept Clin Biochem, Barcelona, Spain. (author)
  • deFilippi, ChristopherUniv Maryland, Sch Med, Dept Med, Baltimore, MD 21201 USA. (author)
  • McCord, JamesHenry Ford Heart & Vasc Inst, Henry Ford Hlth Syst, Detroit, MI USA. (author)
  • Body, RichardCent Manchester Univ Hosp NHS Fdn Trust, Manchester, Lancs, England. (author)
  • Panteghini, MauroUniv Milan, Sch Med, Dept Biomed & Clin Sci Luigi Sacco, Milan, Italy. (author)
  • Jernberg, TomasKarolinska Institutet (author)
  • Plebani, MarioUniv Hosp Padova, Dept Lab Med, Padua, Italy. (author)
  • Verschuren, FranckClin Univ St Luc, Dept Acute Med, Brussels, Belgium.;Catholic Univ Louvain, Brussels, Belgium. (author)
  • French, JohnLiverpool Hosp, Liverpool, NSW, Australia.;Univ New S Wales, Liverpool, NSW, Australia. (author)
  • Christenson, RobertUniv Maryland, Sch Med, Dept Pathol, Baltimore, MD 21201 USA. (author)
  • Weiser, SilviaRoche Diagnost Germany, Penzberg, Germany. (author)
  • Bendig, GarnetRoche Diagnost Germany, Penzberg, Germany. (author)
  • Dilba, PeterRoche Diagnost Germany, Penzberg, Germany. (author)
  • Lindahl, BertilUppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)belin227 (author)
  • Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.;Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.Univ Heidelberg Hosp, Heidelberg, Germany. (creator_code:org_t)

Related titles

  • In:Annals of Emergency Medicine: Elsevier BV68:1, s. 76-870196-06441097-6760

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