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  • Lopez-Ayala, PedroUniv Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.;Global Res Acute Condit Team Network, Rome, Italy. (författare)

Novel Criteria for the Observe-Zone of the ESC 0/1 h-hs-cTnT Algorithm

  • Artikel/kapitelEngelska2021

Förlag, utgivningsår, omfång ...

  • Wolters Kluwer,2021
  • printrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:uu-455871
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-455871URI
  • https://doi.org/10.1161/CIRCULATIONAHA.120.052982DOI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

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Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • BACKGROUND: The non-ST-segment-elevation myocardial infarction (NSTEMI) guidelines of the European Society of Cardiology (ESC) recommend a 3h cardiac troponin determination in patients triaged to the observe-zone of the ESC 0/1h-algorithm; however, no specific cutoff for further triage is endorsed. Recently, a specific cutoff for 0/3h high-sensitivity cardiac troponin T (hs-cTnT) change (7 ng/L) was proposed, warranting external validation. METHODS: Patients presenting with acute chest discomfort to the emergency department were prospectively enrolled into an international multicenter diagnostic study. Final diagnoses were centrally adjudicated by 2 independent cardiologists applying the fourth universal definition of myocardial infarction, on the basis of complete cardiac workup, cardiac imaging, and serial hs-cTnT. Hs-cTnT concentrations were measured at presentation, after 1 hour, and after 3 hours. The objective was to externally validate the proposed cutoff, and if necessary, derive and internally as well as externally validate novel 0/3h-criteria for the observe-zone of the ESC 0/1h-hs-cTnT-algorithm in an independent multicenter cohort. RESULTS: Among 2076 eligible patients, application of the ESC 0/1h-hs-cTnT-algorithm triaged 1512 patients (72.8%) to either rule out or rule in NSTEMI, leaving 564 patients (27.2%) in the observe-zone (adjudicated NSTEMI prevalence, 120/564 patients, 21.3%). The suggested 0/3h-hs-cTnT-change of <7 ng/L triaged 517 patients (91.7%) toward rule-out, resulting in a sensitivity of 33.3% (95% CI, 25.5-42.2), missing 80 patients with NSTEMI, and >= 7 ng/L triaged 47 patients toward rule-in (8.3%), resulting in a specificity of 98.4% (95% CI, 96.8-99.2). Novel derived 0/3h-criteria for the observe-zone patients ruled out NSTEMI with a 3h hs-cTnT concentration <15 ng/L and a 0/3h-hs-cTnT absolute change <4 ng/L, triaging 138 patients (25%) toward rule-out, resulting in a sensitivity of 99.2% (95% CI, 96.0-99.9), missing 1 patient with NSTEMI. A 0/3h-hs-cTnT absolute change >= 6 ng/L triaged 63 patients (11.2%) toward rule-in, resulting in a specificity of 98% (95% CI, 96.2-98.9) Thereby, the novel 0/3h-criteria reduced the number of patients in the observe zone by 36%s and the number of type 1 myocardial infarction by 50%. Findings were confirmed in both internal and external validation. CONCLUSIONS: A combination of a 3h-hs-cTnT concentration (<15 ng/L) and a 0/3h absolute change (<4 ng/L) is necessary to safely rule out NSTEMI in patients remaining in the observe-zone of the ESC 0/1h-hs-cTnT-algorithm.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Nestelberger, ThomasUniv Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.;Global Res Acute Condit Team Network, Rome, Italy.;Univ British Columbia, Vancouver Gen Hosp, Div Cardiol, Vancouver, BC, Canada. (författare)
  • Boeddinghaus, JasperUniv Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.;Global Res Acute Condit Team Network, Rome, Italy. (författare)
  • Koechlin, LucaUniv Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiac Surg, Basel, Switzerland.;Global Res Acute Condit Team Network, Rome, Italy. (författare)
  • Ratmann, Paul DavidUniv Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.;Global Res Acute Condit Team Network, Rome, Italy. (författare)
  • Strebel, IvoUniv Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.;Global Res Acute Condit Team Network, Rome, Italy. (författare)
  • Gehrke, JulianeUniv Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.;Global Res Acute Condit Team Network, Rome, Italy. (författare)
  • Meier, SeverinUniv Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland. (författare)
  • Walter, JoanUniv Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.;Univ Zurich Hosp, Inst Diagnost & Intervent Radiol, Zurich, Switzerland. (författare)
  • Rubini Gimenez, MariaGlobal Res Acute Condit Team Network, Rome, Italy.;Dept Cardiol, Herzzentrum, Leipzig, Germany. (författare)
  • Mutschler, EugenioUniv Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland. (författare)
  • Miro, OscarGlobal Res Acute Condit Team Network, Rome, Italy.;Univ Barcelona, Hosp Clin, Emergency Dept, Barcelona, Spain. (författare)
  • Lopez-Barbeito, BeatrizGlobal Res Acute Condit Team Network, Rome, Italy.;Univ Barcelona, Hosp Clin, Emergency Dept, Barcelona, Spain. (författare)
  • Martin-Sanchez, Francisco JavierGlobal Res Acute Condit Team Network, Rome, Italy.;Hosp Clin San Carlos, Emergency Dept, Madrid, Spain. (författare)
  • Rodriguez-Adrada, EstherHosp Clin San Carlos, Emergency Dept, Madrid, Spain. (författare)
  • Keller, Dagmar I.Univ Zurich Hosp, Emergency Dept, Zurich, Switzerland. (författare)
  • Newby, L. KristinDuke Univ, Med Ctr, Div Cardiol, Dept Med, Durham, NC USA.;Duke Univ, Med Ctr, Div Cardiol, Duke Clin Res Inst, Durham, NC USA. (författare)
  • Twerenbold, RaphaelUniv Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.;Global Res Acute Condit Team Network, Rome, Italy.;Univ Ctr Cardiovasc Sci, Hamburg, Germany.;Univ Heart & Vasc Ctr, Dept Cardiol, Hamburg, Germany. (författare)
  • Giannitsis, EvangelosUniv Heidelberg Hosp, Dept Med 3, Heidelberg, Germany. (författare)
  • Lindahl, Bertil,1957-Uppsala universitet,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)belin227 (författare)
  • Mueller, ChristianUniv Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.;Global Res Acute Condit Team Network, Rome, Italy. (författare)
  • Univ Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.;Global Res Acute Condit Team Network, Rome, Italy.Univ Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.;Global Res Acute Condit Team Network, Rome, Italy.;Univ British Columbia, Vancouver Gen Hosp, Div Cardiol, Vancouver, BC, Canada. (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:Circulation: Wolters Kluwer144:10, s. 773-7870009-73221524-4539

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