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  • Boeddinghaus, JasperUniv 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 (author)

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

  • Article/chapterEnglish2018

Publisher, publication year, extent ...

  • 2018-08-29
  • OXFORD UNIV PRESS,2018
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:uu-371504
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-371504URI
  • https://doi.org/10.1093/eurheartj/ehy514DOI

Supplementary language notes

  • Language:English
  • Summary in:English

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

Notes

  • 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.

Subject headings and genre

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  • Nestelberger, ThomasUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy (author)
  • Twerenbold, RaphaelUniv 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 (author)
  • Neumann, Johannes TobiasHamburg Univ Heart Ctr, Dept Gen & Intervent Cardiol, Martinistr 52, D-20246 Hamburg, Germany (author)
  • Lindahl, BertaUppsala universitet,Institutionen för medicinska vetenskaper,Uppsala kliniska forskningscentrum (UCR) (author)
  • Giannitsis, EvangelosHeidelberg Univ, Med Klin 3, Neuenheimer Feld 410, D-69120 Heidelberg, Germany (author)
  • Soerensen, Nils ArneHamburg Univ Heart Ctr, Dept Gen & Intervent Cardiol, Martinistr 52, D-20246 Hamburg, Germany (author)
  • Badertscher, PatrickUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy (author)
  • Jann, Janina E.Univ Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy (author)
  • Wussler, DesireeUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy (author)
  • Puelacher, ChristianUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy (author)
  • Gimenez, Maria RubiniUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy (author)
  • Wildi, KarinUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy (author)
  • Strebel, IvoUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy (author)
  • de Lavallaz, Jeanne Du FayUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy (author)
  • Selman, FarahUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland (author)
  • Sabti, ZaidUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy (author)
  • Kozhuharov, NikolaUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy (author)
  • Potlukova, EliskaUniv 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 (author)
  • Rentsch, KatharinaUniv Basel, Lab Med, Univ Hosp Basel, Petersgraben 4, CH-4031 Basel, Switzerland (author)
  • Miro, Oscar3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy;Hosp Clin Barcelona, Emergency Dept, Calle Villarroel 170, Barcelona 08036, Catalonia, Spain (author)
  • Martin-Sanchez, F. Javier3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy;Hosp Clin San Carlos, Serv Urgencias, Prof Martin Lagos S-N, Madrid 28040, Spain (author)
  • Morawiec, Beata3GREAT 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 (author)
  • Parenica, Jiri3GREAT 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 (author)
  • Lohrmann, JensUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland (author)
  • Kloos, WandaUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland (author)
  • Buser, AndreasSwiss Red Cross, Blood Transfus Ctr, Hebelstr 10, CH-4056 Basel, Switzerland;Univ Basel, Univ Hosp Basel, Dept Hematol, Petersgraben 4, CH-4031 Basel, Switzerland (author)
  • Geigy, NicolasKantonsspital Liestal, Emergency Dept, Rheinstr 26, CH-4410 Liestal, Switzerland (author)
  • Keller, Dagmar, IUniv Hosp Zurich, Emergency Dept, Ramistr 100, CH-8091 Zurich, Switzerland (author)
  • Osswald, StefanUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland (author)
  • Reichlin, TobiasUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy (author)
  • Westermann, DirkHamburg Univ Heart Ctr, Dept Gen & Intervent Cardiol, Martinistr 52, D-20246 Hamburg, Germany (author)
  • Blankenberg, StefanHamburg Univ Heart Ctr, Dept Gen & Intervent Cardiol, Martinistr 52, D-20246 Hamburg, Germany (author)
  • Mueller, ChristianUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy (author)
  • 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, ItalyUniv Basel, CRIB, Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland;3GREAT Network, Via Antonio Serra 54, I-00191 Rome, Italy (creator_code:org_t)

Related titles

  • In:European Heart Journal: OXFORD UNIV PRESS39:42, s. 3780-37940195-668X1522-9645

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