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Immediate Rule-Out of Acute Myocardial Infarction Using Electrocardiogram and Baseline High-Sensitivity Troponin I

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Immediate Rule-Out of Acute Myocardial Infarction Using Electrocardiogram and Baseline High-Sensitivity Troponin I. / Neumann, Johannes Tobias; Sörensen, Nils Arne; Ojeda, Francisco; Schwemer, Tjark; Lehmacher, Jonas; Gönner, Saskia; Jarsetz, Nikolas; Keller, Till; Schaefer, Sarina; Renné, Thomas; Landmesser, Ulf; Clemmensen, Peter; Makarova, Nataliya; Schnabel, Renate B; Zeller, Tanja; Karakas, Mahir; Pickering, John W; Than, Martin; Parsonage, William; Greenslade, Jaimi; Cullen, Louise; Westermann, Dirk; Blankenberg, Stefan.

in: CLIN CHEM, Jahrgang 63, Nr. 1, 01.2017, S. 394-402.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Neumann, JT, Sörensen, NA, Ojeda, F, Schwemer, T, Lehmacher, J, Gönner, S, Jarsetz, N, Keller, T, Schaefer, S, Renné, T, Landmesser, U, Clemmensen, P, Makarova, N, Schnabel, RB, Zeller, T, Karakas, M, Pickering, JW, Than, M, Parsonage, W, Greenslade, J, Cullen, L, Westermann, D & Blankenberg, S 2017, 'Immediate Rule-Out of Acute Myocardial Infarction Using Electrocardiogram and Baseline High-Sensitivity Troponin I', CLIN CHEM, Jg. 63, Nr. 1, S. 394-402. https://doi.org/10.1373/clinchem.2016.262659

APA

Neumann, J. T., Sörensen, N. A., Ojeda, F., Schwemer, T., Lehmacher, J., Gönner, S., Jarsetz, N., Keller, T., Schaefer, S., Renné, T., Landmesser, U., Clemmensen, P., Makarova, N., Schnabel, R. B., Zeller, T., Karakas, M., Pickering, J. W., Than, M., Parsonage, W., ... Blankenberg, S. (2017). Immediate Rule-Out of Acute Myocardial Infarction Using Electrocardiogram and Baseline High-Sensitivity Troponin I. CLIN CHEM, 63(1), 394-402. https://doi.org/10.1373/clinchem.2016.262659

Vancouver

Neumann JT, Sörensen NA, Ojeda F, Schwemer T, Lehmacher J, Gönner S et al. Immediate Rule-Out of Acute Myocardial Infarction Using Electrocardiogram and Baseline High-Sensitivity Troponin I. CLIN CHEM. 2017 Jan;63(1):394-402. https://doi.org/10.1373/clinchem.2016.262659

Bibtex

@article{0fb52d5649734676b1ca229f8ef92633,
title = "Immediate Rule-Out of Acute Myocardial Infarction Using Electrocardiogram and Baseline High-Sensitivity Troponin I",
abstract = "AIMS: Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG) to rule out AMI.METHODS: Troponin I measured with a high-sensitivity assay (hs-TnI) was determined at admission in 1040 patients presenting with suspected AMI (BACC study). To rule out AMI we calculated the negative predictive value (NPV) utilizing the optimal hs-TnI cutoff combined with a low risk ECG. The results were validated in 3566 patients with suspected AMI [2-h Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) studies]. Patients were followed for 6 or 12 months.RESULTS: 184 of all patients were diagnosed with AMI. An hs-TnI cutoff of 3 ng/L resulted in a NPV of 99.3% (CI 97.3-100.0), ruling out 35% of all non-AMI patients. Adding the information of a low risk ECG resulted in a 100% (CI 97.5-100.0) NPV (28% ruled out). The 2 validation cohorts replicated the high NPV of this approach. The follow-up mortality in the ruled out population was low (0 deaths in BACC and Stenocardia, 1 death in ADAPT).CONCLUSIONS: A single hs-TnI measurement on admission combined with a low risk ECG appears to rule out AMI safely without need for serial troponin testing.TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02355457).",
keywords = "Acute Disease, Aged, Biomarkers, Electrocardiography, Female, Humans, Male, Middle Aged, Myocardial Infarction, Troponin I, Clinical Trial, Journal Article",
author = "Neumann, {Johannes Tobias} and S{\"o}rensen, {Nils Arne} and Francisco Ojeda and Tjark Schwemer and Jonas Lehmacher and Saskia G{\"o}nner and Nikolas Jarsetz and Till Keller and Sarina Schaefer and Thomas Renn{\'e} and Ulf Landmesser and Peter Clemmensen and Nataliya Makarova and Schnabel, {Renate B} and Tanja Zeller and Mahir Karakas and Pickering, {John W} and Martin Than and William Parsonage and Jaimi Greenslade and Louise Cullen and Dirk Westermann and Stefan Blankenberg",
note = "{\textcopyright} 2016 American Association for Clinical Chemistry.",
year = "2017",
month = jan,
doi = "10.1373/clinchem.2016.262659",
language = "English",
volume = "63",
pages = "394--402",
journal = "CLIN CHEM",
issn = "0009-9147",
publisher = "American Association for Clinical Chemistry Inc.",
number = "1",

}

RIS

TY - JOUR

T1 - Immediate Rule-Out of Acute Myocardial Infarction Using Electrocardiogram and Baseline High-Sensitivity Troponin I

AU - Neumann, Johannes Tobias

AU - Sörensen, Nils Arne

AU - Ojeda, Francisco

AU - Schwemer, Tjark

AU - Lehmacher, Jonas

AU - Gönner, Saskia

AU - Jarsetz, Nikolas

AU - Keller, Till

AU - Schaefer, Sarina

AU - Renné, Thomas

AU - Landmesser, Ulf

AU - Clemmensen, Peter

AU - Makarova, Nataliya

AU - Schnabel, Renate B

AU - Zeller, Tanja

AU - Karakas, Mahir

AU - Pickering, John W

AU - Than, Martin

AU - Parsonage, William

AU - Greenslade, Jaimi

AU - Cullen, Louise

AU - Westermann, Dirk

AU - Blankenberg, Stefan

N1 - © 2016 American Association for Clinical Chemistry.

PY - 2017/1

Y1 - 2017/1

N2 - AIMS: Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG) to rule out AMI.METHODS: Troponin I measured with a high-sensitivity assay (hs-TnI) was determined at admission in 1040 patients presenting with suspected AMI (BACC study). To rule out AMI we calculated the negative predictive value (NPV) utilizing the optimal hs-TnI cutoff combined with a low risk ECG. The results were validated in 3566 patients with suspected AMI [2-h Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) studies]. Patients were followed for 6 or 12 months.RESULTS: 184 of all patients were diagnosed with AMI. An hs-TnI cutoff of 3 ng/L resulted in a NPV of 99.3% (CI 97.3-100.0), ruling out 35% of all non-AMI patients. Adding the information of a low risk ECG resulted in a 100% (CI 97.5-100.0) NPV (28% ruled out). The 2 validation cohorts replicated the high NPV of this approach. The follow-up mortality in the ruled out population was low (0 deaths in BACC and Stenocardia, 1 death in ADAPT).CONCLUSIONS: A single hs-TnI measurement on admission combined with a low risk ECG appears to rule out AMI safely without need for serial troponin testing.TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02355457).

AB - AIMS: Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG) to rule out AMI.METHODS: Troponin I measured with a high-sensitivity assay (hs-TnI) was determined at admission in 1040 patients presenting with suspected AMI (BACC study). To rule out AMI we calculated the negative predictive value (NPV) utilizing the optimal hs-TnI cutoff combined with a low risk ECG. The results were validated in 3566 patients with suspected AMI [2-h Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) studies]. Patients were followed for 6 or 12 months.RESULTS: 184 of all patients were diagnosed with AMI. An hs-TnI cutoff of 3 ng/L resulted in a NPV of 99.3% (CI 97.3-100.0), ruling out 35% of all non-AMI patients. Adding the information of a low risk ECG resulted in a 100% (CI 97.5-100.0) NPV (28% ruled out). The 2 validation cohorts replicated the high NPV of this approach. The follow-up mortality in the ruled out population was low (0 deaths in BACC and Stenocardia, 1 death in ADAPT).CONCLUSIONS: A single hs-TnI measurement on admission combined with a low risk ECG appears to rule out AMI safely without need for serial troponin testing.TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02355457).

KW - Acute Disease

KW - Aged

KW - Biomarkers

KW - Electrocardiography

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Troponin I

KW - Clinical Trial

KW - Journal Article

U2 - 10.1373/clinchem.2016.262659

DO - 10.1373/clinchem.2016.262659

M3 - SCORING: Journal article

C2 - 27903616

VL - 63

SP - 394

EP - 402

JO - CLIN CHEM

JF - CLIN CHEM

SN - 0009-9147

IS - 1

ER -