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A 1-h Combination A...
A 1-h Combination Algorithm Allows Fast Rule-Out and Rule-In of Major Adverse Cardiac Events
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- MOKHTARI, ARASH (author)
- Lund 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.
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- Cedercrantz-Borna, Catharina (author)
- Lund 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.
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- GILJE, PATRIK (author)
- Skåne University Hospital,Skane Univ Hosp, Dept Cardiol, Lund, Sweden.
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- Tydén, Patrik (author)
- Skåne University Hospital
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- Lindahl, Bertil (author)
- Uppsala universitet,Uppsala University,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Nilsson, Hans-Jörgen (author)
- Skåne University Hospital,Skane Univ Hosp, Dept Cardiol, Lund, Sweden.
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- KHOSHNOOD, ARDAVAN (author)
- Lund 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
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- Björk, Jonas (author)
- Lund 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.
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- Ekelund, Ulf (author)
- Lund 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.
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(creator_code:org_t)
- Elsevier BV, 2016
- 2016
- English 10 s.
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In: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 67:13, s. 1531-1540
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Abstract
Subject headings
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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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Annan klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Other Clinical Medicine (hsv//eng)
Keyword
- Troponin
- ACS
- Chest pain
- Acute coronary syndrome
- Troponin
- AKS
- Bröstsmärta
- Akut Koronart Syndrom
- acute coronary syndrome
Publication and Content Type
- art (subject category)
- ref (subject category)
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