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A 1-h Combination A...
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MOKHTARI, ARASHLund University,Lunds universitet,Medicin, Lund,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Medicine, Lund,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital,Skane Univ Hosp, Dept Internal & Emergency Med, Lund, Sweden.;Skane Univ Hosp, Dept Cardiol, Lund, Sweden.;Lund Univ, Dept Clin Sci Lund, Lund, Sweden.
(författare)
A 1-h Combination Algorithm Allows Fast Rule-Out and Rule-In of Major Adverse Cardiac Events
- Artikel/kapitelEngelska2016
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LIBRIS-ID:oai:lup.lub.lu.se:4ffbe584-a2d9-48bb-89b9-4a50e47be0b2
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https://lup.lub.lu.se/record/4ffbe584-a2d9-48bb-89b9-4a50e47be0b2URI
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https://doi.org/10.1016/j.jacc.2016.01.059DOI
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-292997URI
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Språk:engelska
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Sammanfattning på:engelska
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Ämneskategori:art swepub-publicationtype
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Background A 1-h algorithm based on high-sensitivity cardiac troponin T (hs-cTnT) testing at presentation and again 1 h thereafter has been shown to accurately rule out acute myocardial infarction. Objectives The goal of the study was to evaluate the diagnostic accuracy of the 1-h algorithm when supplemented with patient history and an electrocardiogram (ECG) (the extended algorithm) for predicting 30-day major adverse cardiac events (MACE) and to compare it with the algorithm using hs-cTnT alone (the troponin algorithm). Methods This prospective observational study enrolled consecutive patients presenting to the emergency department (ED) with chest pain, for whom hs-cTnT testing was ordered at presentation. Hs-cTnT results at 1 h and the ED physician’s assessments of patient history and ECG were collected. The primary outcome was an adjudicated diagnosis of 30-day MACE defined as acute myocardial infarction, unstable angina, cardiogenic shock, ventricular arrhythmia, atrioventricular block, cardiac arrest, or death of a cardiac or unknown cause. Results In the final analysis, 1,038 patients were included. The extended algorithm identified 60% of all patients for rule-out and had a higher sensitivity than the troponin algorithm (97.5% vs. 87.6%; p < 0.001). The negative predictive value was 99.5% and the likelihood ratio was 0.04 with the extended algorithm versus 97.8% and 0.17, respectively, with the troponin algorithm. The extended algorithm ruled-in 14% of patients with a higher sensitivity (75.2% vs. 56.2%; p < 0.001) but a slightly lower specificity (94.0% vs. 96.4%; p < 0.001) than the troponin algorithm. The rule-in arms of both algorithms had a likelihood ratio >10. Conclusions A 1-h combination algorithm allowed fast rule-out and rule-in of 30-day MACE in a majority of ED patients with chest pain and performed better than the troponin-alone algorithm.
Ämnesord och genrebeteckningar
Biuppslag (personer, institutioner, konferenser, titlar ...)
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Cedercrantz-Borna, CatharinaLund University,Lunds universitet,Medicin, Lund,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Medicine, Lund,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Helsingborg Hospital,Lund Univ, Dept Clin Sci Lund, Lund, Sweden.;Helsingborg Gen Hosp, Div Specialised Local Hlth Care, Helsingborg, Sweden.(Swepub:lu)kard-cbo
(författare)
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GILJE, PATRIKSkåne University Hospital,Skane Univ Hosp, Dept Cardiol, Lund, Sweden.(Swepub:lu)smi-pty
(författare)
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Tydén, PatrikSkåne University Hospital(Swepub:lu)smi-pty
(författare)
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Lindahl, BertilUppsala universitet,Uppsala University,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)belin227
(författare)
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Nilsson, Hans-JörgenSkåne University Hospital,Skane Univ Hosp, Dept Cardiol, Lund, Sweden.
(författare)
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KHOSHNOOD, ARDAVANLund University,Lunds universitet,Medicin, Lund,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Medicine, Lund,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital(Swepub:lu)med-akh
(författare)
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Björk, JonasLund University,Lunds universitet,Avdelningen för arbets- och miljömedicin,Institutionen för laboratoriemedicin,Medicinska fakulteten,Division of Occupational and Environmental Medicine, Lund University,Department of Laboratory Medicine,Faculty of Medicine,Lund Univ, Occupat & Environm Med, Lund, Sweden.(Swepub:lu)ymed-jbj
(författare)
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Ekelund, UlfLund University,Lunds universitet,Medicin, Lund,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Medicine, Lund,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital,Skane Univ Hosp, Dept Internal & Emergency Med, Lund, Sweden.;Lund Univ, Dept Clin Sci Lund, Lund, Sweden.(Swepub:lu)mphy-uek
(författare)
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Medicin, LundSektion II
(creator_code:org_t)
Sammanhörande titlar
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Ingår i:Journal of the American College of Cardiology: Elsevier BV67:13, s. 1531-15400735-10971558-3597
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