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Multicenter Evaluat...
Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T
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- Mueller, Christian (author)
- Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.;Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.
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- Giannitsis, Evangelos (author)
- Univ Heidelberg Hosp, Heidelberg, Germany.
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- Christ, Michael (author)
- Paracelsus Med Univ, Gen Hosp, Dept Emergency & Crit Care Med, Nurnberg, Germany.
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- Ordonez-Llanos, Jorge (author)
- Inst Invest Biomed St Pau, Dept Clin Biochem, Barcelona, Spain.
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- deFilippi, Christopher (author)
- Univ Maryland, Sch Med, Dept Med, Baltimore, MD 21201 USA.
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- McCord, James (author)
- Henry Ford Heart & Vasc Inst, Henry Ford Hlth Syst, Detroit, MI USA.
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- Body, Richard (author)
- Cent Manchester Univ Hosp NHS Fdn Trust, Manchester, Lancs, England.
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- Panteghini, Mauro (author)
- Univ Milan, Sch Med, Dept Biomed & Clin Sci Luigi Sacco, Milan, Italy.
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- Jernberg, Tomas (author)
- Karolinska Institutet
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- Plebani, Mario (author)
- Univ Hosp Padova, Dept Lab Med, Padua, Italy.
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- Verschuren, Franck (author)
- Clin Univ St Luc, Dept Acute Med, Brussels, Belgium.;Catholic Univ Louvain, Brussels, Belgium.
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- French, John (author)
- Liverpool Hosp, Liverpool, NSW, Australia.;Univ New S Wales, Liverpool, NSW, Australia.
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- Christenson, Robert (author)
- Univ Maryland, Sch Med, Dept Pathol, Baltimore, MD 21201 USA.
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- Weiser, Silvia (author)
- Roche Diagnost Germany, Penzberg, Germany.
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- Bendig, Garnet (author)
- Roche Diagnost Germany, Penzberg, Germany.
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- Dilba, Peter (author)
- Roche Diagnost Germany, Penzberg, Germany.
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- Lindahl, Bertil (author)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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Univ Basel Hosp, Dept Cardiol, Basel, Switzerland;Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland. Univ Heidelberg Hosp, Heidelberg, Germany. (creator_code:org_t)
- Elsevier BV, 2016
- 2016
- English.
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In: Annals of Emergency Medicine. - : Elsevier BV. - 0196-0644 .- 1097-6760. ; 68:1, s. 76-87
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http://www.annemergm...
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Abstract
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- Study objective: We aim to prospectively validate the diagnostic accuracy of the recently developed 0-h/1-h algorithm, using high-sensitivity cardiac troponin T (hs-cTnT) for the early rule-out and rule-in of acute myocardial infarction. Methods: We enrolled patients presenting with suspected acute myocardial infarction and recent (<6 hours) onset of symptoms to the emergency department in a global multicenter diagnostic study. Hs-cTnT (Roche Diagnostics) and sensitive cardiac troponin I (Siemens Healthcare) were measured at presentation and after 1 hour, 2 hours, and 4 to 14 hours in a central laboratory. Patient triage according to the predefined hs-cTnT 0-hour/1-hour algorithm (hs-cTnT beloow 12 ng/L and Delta 1 hour below 3 ng/L to rule out; hs-cTnT at least 52 ng/L r Delta 1 hour at least 5 ng/L to rule in; remaining patients to the "observational zone") was compared against a centrally adjudicated final diagnosis by 2 independent cardiologists (reference standard). The final diagnosis was based on all available information, including coronary angiography and echocardiography results, follow-up data, and serial measurements of sensitive cardiac troponin I, whereas adjudicators remained blinded to hs-cTnT. Results: Among 1,282 patients enrolled, acute myocardial infarction was the final diagnosis for 213 (16.6%) patients. Applying the hs-cTnT 0-hour/1-hour algorithm, 813 (63.4%) patients were classified as rule out, 184 (14.4%) were classified as rule in, and 285 (22.2%) were triaged to the observational zone. This resulted in a negative predictive value and sensitivity for acute myocardial infarction of 99.1% (95% confidence interval [CI] 98.2% to 99.7%) and 96.7% (95% CI 93.4% to 98.7%) in the rule-out zone (7 patients with false-negative results), a positive predictive value and specificity for acute myocardial infarction of 77.2% (95% CI 70.4% to 83.0%) and 96.1% (95% CI 94.7% to 97.2%) in the rule-in zone, and a prevalence of acute myocardial infarction of 22.5% in the observational zone. Conclusion: The hs-cTnT 0-hour/1-hour algorithm performs well for early rule-out and rule-in of acute myocardial infarction.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
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- ref (subject category)
- art (subject category)
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Mueller, Christi ...
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Giannitsis, Evan ...
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Christ, Michael
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Ordonez-Llanos, ...
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deFilippi, Chris ...
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McCord, James
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Body, Richard
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Panteghini, Maur ...
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Jernberg, Tomas
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Plebani, Mario
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Verschuren, Fran ...
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French, John
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Christenson, Rob ...
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Weiser, Silvia
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Bendig, Garnet
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Dilba, Peter
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Lindahl, Bertil
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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Uppsala University
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Karolinska Institutet