Personalized diagnosis in suspected myocardial infarction

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Personalized diagnosis in suspected myocardial infarction

Neumann, Johannes Tobias (författare): Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany.;German Ctr Cardiovasc Res DZHK, Partner SiteHamburg Kiel Lubeck, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Populat Hlth Res Dept, Hamburg, Germany.;Monash Univ, Sch Publ Hlth & Prevent Med, Dept Epidemiol & Prevent Med, Melbourne, Australia.,Monash University,German Centre for Cardiovascular Research,University Medical Center Hamburg-Eppendorf

Twerenbold, Raphael (författare): Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany.;German Ctr Cardiovasc Res DZHK, Partner SiteHamburg Kiel Lubeck, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Populat Hlth Res Dept, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Ctr Cardiovasc Sci, Univ Heart & Vasc Ctr Hamburg, Hamburg, Germany.

Ojeda, Francisco (författare): Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Populat Hlth Res Dept, Hamburg, Germany.

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Aldous, Sally (författare): Christchurch Hosp, Dept Cardiol, Christchurch, New Zealand.

Allen, Brandon (författare): Univ Florida, Coll Med, Dept Emergency Med, Gainesville, FL USA.

Mokhtari, A. (författare): Lund University,Lunds universitet,NPWT teknologin,Forskargrupper vid Lunds universitet,Skonsammare hjärtkirurgi,NPWT technology,Lund University Research Groups,Less invasive cardiac surgery,Skåne University Hospital

Babel, Hugo (författare): Medizincampus Davos, CardioCARE, Davos, Switzerland.

Christenson, Robert (författare): Univ Maryland, Sch Med, Dept Pathol, Baltimore, MD USA.

Cullen, Louise (författare): Royal Brisbane & Womens Hosp, Dept Emergency Med, Herston, Qld, Australia.

Di Carluccio, Eleonora (författare): Medizincampus Davos, CardioCARE, Davos, Switzerland.

Doudesis, Dimitrios (författare): Univ Edinburgh, BHF Ctr Cardiovasc Sci, Edinburgh, Scotland.

Ekelund, U. (författare): Lund University,Lunds universitet,Akutsjukvård,Forskargrupper vid Lunds universitet,Emergency medicine,Lund University Research Groups,Skåne University Hospital

Giannitsis, Evangelos (författare): Heidelberg Univ Hosp, Dept Cardiol, Heidelberg, Germany.

Greenslade, Jaimi (författare): Royal Brisbane & Womens Hosp, Dept Emergency Med, Herston, Qld, Australia.

Inoue, Kenji (författare): Juntendo Univ, Nerima Hosp, Tokyo, Japan.

Jernberg, Tomas (författare): Karolinska Institutet,Karolinska Inst, Danderyd Univ Hosp, Dept Clin Sci, Stockholm, Sweden.

Kavsak, Peter (författare): McMaster Univ, Dept Pathol & Mol Med, Hamilton, ON, Canada.

Keller, Till (författare): Kerckhoff Heart & Thorax Ctr, Dept Cardiol, Bad Nauheim, Germany.

Lee, Kuan Ken (författare): Univ Edinburgh, BHF Ctr Cardiovasc Sci, Edinburgh, Scotland.

Lindahl, Bertil, 1957- (författare): Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)

Lorenz, Thiess (författare): Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany.;German Ctr Cardiovasc Res DZHK, Partner SiteHamburg Kiel Lubeck, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Populat Hlth Res Dept, Hamburg, Germany.

Mahler, Simon (författare): Wake Forest Sch Med, Dept Emergency Med, Winston Salem, NC USA.

Mills, Nicholas (författare): Univ Edinburgh, BHF Ctr Cardiovasc Sci, Edinburgh, Scotland.

Mokhtari, Arash (författare): Lund Univ, Skane Univ Hosp, Dept Internal Med & Emergency Med, Lund, Sweden.;Lund Univ, Skane Univ Hosp, Dept Cardiol, Lund, Sweden.

Parsonage, William (författare): Queensland Univ Technol, Australian Ctr Hlth Serv Innovat, Kelvin Grove, Australia.

Pickering, John (författare): Dept Med, Christchurch, New Zealand.;Univ Otago, Christchurch Hosp, Emergency Dept, Christchurch, New Zealand.

Pemberton, Christopher (författare): Univ Otago, Christchurch Heart Inst, Dept Med, Christchurch, New Zealand.

Reich, Christoph (författare): Heidelberg Univ Hosp, Dept Cardiol, Heidelberg, Germany.

Richards, A. Mark (författare): Dept Med, Christchurch, New Zealand.;Univ Otago, Christchurch Hosp, Emergency Dept, Christchurch, New Zealand.

Sandoval, Yader (författare): Abbott NW Hosp, Minneapolis Heart Inst, Minneapolis, MN USA.;Minneapolis Heart Inst Fdn, Minneapolis, MN USA.

Than, Martin A. (författare): Dept Med, Christchurch, New Zealand.;Univ Otago, Christchurch Hosp, Emergency Dept, Christchurch, New Zealand.

Toprak, Betül (författare): Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany.;German Ctr Cardiovasc Res DZHK, Partner SiteHamburg Kiel Lubeck, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Populat Hlth Res Dept, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Ctr Cardiovasc Sci, Univ Heart & Vasc Ctr Hamburg, Hamburg, Germany.

Troughton, Richard (författare): Univ Otago, Christchurch Heart Inst, Dept Med, Christchurch, New Zealand.

Worster, Andrew (författare): McMaster Univ, Div Emergency Med, Hamilton, ON, Canada.

Zeller, Tanja (författare): Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany.;German Ctr Cardiovasc Res DZHK, Partner SiteHamburg Kiel Lubeck, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Populat Hlth Res Dept, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Ctr Cardiovasc Sci, Univ Heart & Vasc Ctr Hamburg, Hamburg, Germany.

Ziegler, Andreas (författare): Medizincampus Davos, CardioCARE, Davos, Switzerland.;Univ KwaZulu Natal, Sch Math Stat & Comp Sci, Pietermaritzburg, South Africa.

Blankenberg, Stefan (författare): Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany.;German Ctr Cardiovasc Res DZHK, Partner SiteHamburg Kiel Lubeck, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Populat Hlth Res Dept, Hamburg, Germany.,University Medical Center Hamburg-Eppendorf,German Centre for Cardiovascular Research

Apple, FS (författare)

Than, MP (författare)

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Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany;German Ctr Cardiovasc Res DZHK, Partner SiteHamburg Kiel Lubeck, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Populat Hlth Res Dept, Hamburg, Germany.;Monash Univ, Sch Publ Hlth & Prevent Med, Dept Epidemiol & Prevent Med, Melbourne, Australia. Monash University (creator_code:org_t)

Springer, 2023
2023
Engelska.
Ingår i: Clinical Research in Cardiology. - : Springer. - 1861-0684 .- 1861-0692. ; 112, s. 1288-1301

Relaterad länk:: https://doi.org/10.1...; visa fler...; https://uu.diva-port... (primary) (Raw object); http://dx.doi.org/10... (free); https://urn.kb.se/re...; https://doi.org/10.1...; http://kipublication...; https://lup.lub.lu.s...; visa färre...

Tidskriftsartikel (refereegranskat)

Abstract Ämnesord

Stäng

Background: In suspected myocardial infarction (MI), guidelines recommend using high-sensitivity cardiac troponin (hscTn)- based approaches. These require fixed assay-specific thresholds and timepoints, without directly integrating clinical information. Using machine-learning techniques including hs-cTn and clinical routine variables, we aimed to build a digital tool to directly estimate the individual probability of MI, allowing for numerous hs-cTn assays.Methods: In 2,575 patients presenting to the emergency department with suspected MI, two ensembles of machine-learning models using single or serial concentrations of six different hs-cTn assays were derived to estimate the individual MI probability ( ARTEMIS model). Discriminative performance of the models was assessed using area under the receiver operating characteristic curve (AUC) and logLoss. Model performance was validated in an external cohort with 1688 patients and tested for global generalizability in 13 international cohorts with 23,411 patients.Results: Eleven routinely available variables including age, sex, cardiovascular risk factors, electrocardiography, and hs-cTn were included in the ARTEMIS models. In the validation and generalization cohorts, excellent discriminative performance was confirmed, superior to hs-cTn only. For the serial hs-cTn measurement model, AUC ranged from 0.92 to 0.98. Good calibration was observed. Using a single hs-cTn measurement, the ARTEMIS model allowed direct rule-out of MI with very high and similar safety but up to tripled efficiency compared to the guideline- recommended strategy.Conclusion We developed and validated diagnostic models to accurately estimate the individual probability of MI, which allow for variable hs-cTn use and flexible timing of resampling. Their digital application may provide rapid, safe and efficient personalized patient care.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

Acute myocardial infarction
Biomarker
Troponin
Machine learning
Probability
Super learner
Validation
Acute myocardial infarction
Biomarker
Machine learning
Probability
Super learner
Troponin
Validation

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kardiologi

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Av lärosätet: Uppsala universitet; Karolinska Institutet; Lunds universitet

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