Early rule-out and rule-in of myocardial infarction using sensitive cardiac Troponin i
Abstract
Background It is currently unknown, whether and to what extent sensitive cardiac troponin (s-cTn) allows shortening of the time required for safe rule-out and rule-in of acute myocardial infarction (AMI). Methods We aimed to develop and validate early rule-out and rule-in algorithms for AMI using a thoroughly-examined and commonly used s-cTnI assay in a prospective multicenter study including 2173 patients presenting to the emergency department with suspected AMI. S-cTnI was measured in a blinded fashion at 0 h, 1 h, and 2 h. The final diagnosis was centrally adjudicated by two independent cardiologists. In the derivation cohort (n = 1496), we developed 1 h- and 2 h-algorithms assigning patients to "rule-out", "rule-in", or "observe". The algorithms were then prospectively validated in the validation cohort (n = 677). Results AMI was the adjudicated diagnosis in 17% of patients. After applying the s-cTnI 1 h-algorithm developed in the derivation cohort to the validation cohort, 65% of patients were classified as "rule-out", 12% as "rule-in", and 23% to "observe". The negative predictive value for AMI in the "rule-out" group was 98.6% (95% CI, 96.9-99.5), the positive predictive value for AMI in the "rule-in" group 76.3% (95% CI, 65.4-85.1). Overall, 30-day mortality was 0.2% in the "rule-out" group, 1.0% in the "observe" group, and 3.0% in the "rule-in" group. Similar results were obtained for the 2 h-algorithm. Conclusion When used in conjunction with other clinical information including the ECG, a simple algorithm incorporating s-cTnI values at presentation and after 1 h (or 2 h) will allow safe rule-out and accurate rule-in of AMI in the majority of patients.
Bibliografische Daten
| Originalsprache | Englisch |
|---|---|
| ISSN | 0167-5273 |
| DOIs | |
| Status | Veröffentlicht - 22.07.2015 |
| Extern publiziert | Ja |
Anmerkungen des Dekanats
Funding Information:
Professor Mueller has received research grants from the Swiss National Science Foundation and the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, 8sense, Abbott, ALERE, BG-medicine, Biomerieux, Brahms, Cardiorentis, Critical Diagnostics, Nanosphere, Novartis, Roche, Siemens, Singulex, Sphingotec, and the University Hospital Basel, as well as speaker honoraria from Abbott, ALERE, Brahms, Novartis, Roche, and Siemens. We disclose that Dr. Reichlin has received research grants from the Swiss National Science Foundation (PASMP3-136995), the Swiss Heart Foundation, the University of Basel, the Professor Max Cloetta Foundation and the Department of Internal Medicine, University Hospital Basel as well as speakers' honoraria from Brahms and Roche. All other authors declare that they have no conflict of interest with this study. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Funding Information:
This study was supported by research grants from the European Union , the Swiss National Science Foundation , the Swiss Heart Foundation , the Cardiovascular Research Foundation Basel (Switzerland), the University Basel (Switzerland), the University Hospital Basel (Switzerland), 8sense (Puchheim/Munich, Germany), Abbott (North Chicago, Illinois, USA), Beckman Coulter (Brea, California, USA), BRAHMS (Hennigsdorf, Germany), Nanosphere (Illinois, USA), Roche (Basel, Switzerland), Schiller (Baar, Switzerland), and Siemens (Berlin and Munich, Germany).
Publisher Copyright:
© 2015 Elsevier Ireland Ltd. All rights reserved.
