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Novel Criteria for ...
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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 ...
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Wolters Kluwer,2021
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printrdacarrier
Nummerbeteckningar
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LIBRIS-ID:oai:DiVA.org:uu-455871
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-455871URI
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https://doi.org/10.1161/CIRCULATIONAHA.120.052982DOI
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Språk:engelska
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Sammanfattning på:engelska
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Ämneskategori:ref swepub-contenttype
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Ämneskategori:art swepub-publicationtype
Anmärkningar
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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 ...)
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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)
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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)
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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)
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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)
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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)
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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)
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Meier, SeverinUniv Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.
(författare)
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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)
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Rubini Gimenez, MariaGlobal Res Acute Condit Team Network, Rome, Italy.;Dept Cardiol, Herzzentrum, Leipzig, Germany.
(författare)
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Mutschler, EugenioUniv Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.;Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.
(författare)
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Miro, OscarGlobal Res Acute Condit Team Network, Rome, Italy.;Univ Barcelona, Hosp Clin, Emergency Dept, Barcelona, Spain.
(författare)
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Lopez-Barbeito, BeatrizGlobal Res Acute Condit Team Network, Rome, Italy.;Univ Barcelona, Hosp Clin, Emergency Dept, Barcelona, Spain.
(författare)
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Martin-Sanchez, Francisco JavierGlobal Res Acute Condit Team Network, Rome, Italy.;Hosp Clin San Carlos, Emergency Dept, Madrid, Spain.
(författare)
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Rodriguez-Adrada, EstherHosp Clin San Carlos, Emergency Dept, Madrid, Spain.
(författare)
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Keller, Dagmar I.Univ Zurich Hosp, Emergency Dept, Zurich, Switzerland.
(författare)
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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)
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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)
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Giannitsis, EvangelosUniv Heidelberg Hosp, Dept Med 3, Heidelberg, Germany.
(författare)
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Lindahl, Bertil,1957-Uppsala universitet,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)belin227
(författare)
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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)
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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
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Ingår i:Circulation: Wolters Kluwer144:10, s. 773-7870009-73221524-4539
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Lopez-Ayala, Ped ...
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Nestelberger, Th ...
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Boeddinghaus, Ja ...
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Koechlin, Luca
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Ratmann, Paul Da ...
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Strebel, Ivo
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Gehrke, Juliane
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Meier, Severin
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Walter, Joan
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Rubini Gimenez, ...
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Mutschler, Eugen ...
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Miro, Oscar
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Lopez-Barbeito, ...
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Martin-Sanchez, ...
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Rodriguez-Adrada ...
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Keller, Dagmar I ...
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Newby, L. Kristi ...
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Twerenbold, Raph ...
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Giannitsis, Evan ...
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Lindahl, Bertil, ...
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