Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction
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Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction. / Boeddinghaus, Jasper; Nestelberger, Thomas; Twerenbold, Raphael; Neumann, Johannes Tobias; Lindahl, Bertil; Giannitsis, Evangelos; Sörensen, Nils Arne; Badertscher, Patrick; Jann, Janina E; Wussler, Desiree; Puelacher, Christian; Rubini Giménez, Maria; Wildi, Karin; Strebel, Ivo; Du Fay de Lavallaz, Jeanne; Selman, Farah; Sabti, Zaid; Kozhuharov, Nikola; Potlukova, Eliska; Rentsch, Katharina; Miró, Òscar; Martin-Sanchez, F Javier; Morawiec, Beata; Parenica, Jiri; Lohrmann, Jens; Kloos, Wanda; Buser, Andreas; Geigy, Nicolas; Keller, Dagmar I; Osswald, Stefan; Reichlin, Tobias; Westermann, Dirk; Blankenberg, Stefan; Mueller, Christian; APACE, BACC, and TRAPID-AMI Investigators.
in: EUR HEART J, Jahrgang 39, Nr. 42, 07.11.2018, S. 3780-3794.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - Twerenbold, Raphael
AU - Neumann, Johannes Tobias
AU - Lindahl, Bertil
AU - Giannitsis, Evangelos
AU - Sörensen, Nils Arne
AU - Badertscher, Patrick
AU - Jann, Janina E
AU - Wussler, Desiree
AU - Puelacher, Christian
AU - Rubini Giménez, Maria
AU - Wildi, Karin
AU - Strebel, Ivo
AU - Du Fay de Lavallaz, Jeanne
AU - Selman, Farah
AU - Sabti, Zaid
AU - Kozhuharov, Nikola
AU - Potlukova, Eliska
AU - Rentsch, Katharina
AU - Miró, Òscar
AU - Martin-Sanchez, F Javier
AU - Morawiec, Beata
AU - Parenica, Jiri
AU - Lohrmann, Jens
AU - Kloos, Wanda
AU - Buser, Andreas
AU - Geigy, Nicolas
AU - Keller, Dagmar I
AU - Osswald, Stefan
AU - Reichlin, Tobias
AU - Westermann, Dirk
AU - Blankenberg, Stefan
AU - Mueller, Christian
AU - APACE, BACC, and TRAPID-AMI Investigators
PY - 2018/11/7
Y1 - 2018/11/7
N2 - Aims: We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1h-algorithms and to derive and externally validate alternative cut-offs specific to older patients.Methods and results: We prospectively enrolled patients presenting to the emergency department (ED) with symptoms suggestive of acute myocardial infarction in three large diagnostic studies. Final diagnoses were adjudicated by two independent cardiologists. High-sensitivity cardiac troponin (hs-cTn) T and I concentrations were measured at presentation and after 1 h. Patients were stratified according to age [<55 years (young), ≥55 to <70 years (middle-age), ≥70 years (old)]. Rule-out safety of the ESC hs-cTnT 0/1h-algorithm was very high in all age-strata: sensitivity 100% [95% confidence interval (95% CI) 94.9-100] in young, 99.3% (95% CI 96.0-99.9) in middle-age, and 99.3% (95% CI 97.5-99.8) in old patients. Accuracy of rule-in decreased with age: specificity 97.0% (95% CI 95.8-97.9) in young, 96.1% (95% CI 94.5-97.2) in middle-age, and 92.7% (95% CI 90.7-94.3) in older patients. Triage efficacy decreased with increasing age (young 93%, middle-age 80%, old 55%, P < 0.001). Similar results were found for the ESC hs-cTnT 0/1h-algorithm. Alternative, slightly higher cut-off concentrations optimized for older patients maintained very high safety of rule-out, increased specificity of rule-in (P < 0.01), reduced overall efficacy for hs-cTnT (P < 0.01), while maintaining efficacy for hs-cTnI. Findings were confirmed in two validation cohorts (n = 2767).Conclusion: While safety of the ESC 0/1h-algorithms remained very high, increasing age significantly reduced overall efficacy and the accuracy of rule-in. Alternative slightly higher cut-off concentrations may be considered for older patients, particularly if using hs-cTnI.Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT00470587, number NCT00470587 and NCT02355457 (BACC).
AB - Aims: We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1h-algorithms and to derive and externally validate alternative cut-offs specific to older patients.Methods and results: We prospectively enrolled patients presenting to the emergency department (ED) with symptoms suggestive of acute myocardial infarction in three large diagnostic studies. Final diagnoses were adjudicated by two independent cardiologists. High-sensitivity cardiac troponin (hs-cTn) T and I concentrations were measured at presentation and after 1 h. Patients were stratified according to age [<55 years (young), ≥55 to <70 years (middle-age), ≥70 years (old)]. Rule-out safety of the ESC hs-cTnT 0/1h-algorithm was very high in all age-strata: sensitivity 100% [95% confidence interval (95% CI) 94.9-100] in young, 99.3% (95% CI 96.0-99.9) in middle-age, and 99.3% (95% CI 97.5-99.8) in old patients. Accuracy of rule-in decreased with age: specificity 97.0% (95% CI 95.8-97.9) in young, 96.1% (95% CI 94.5-97.2) in middle-age, and 92.7% (95% CI 90.7-94.3) in older patients. Triage efficacy decreased with increasing age (young 93%, middle-age 80%, old 55%, P < 0.001). Similar results were found for the ESC hs-cTnT 0/1h-algorithm. Alternative, slightly higher cut-off concentrations optimized for older patients maintained very high safety of rule-out, increased specificity of rule-in (P < 0.01), reduced overall efficacy for hs-cTnT (P < 0.01), while maintaining efficacy for hs-cTnI. Findings were confirmed in two validation cohorts (n = 2767).Conclusion: While safety of the ESC 0/1h-algorithms remained very high, increasing age significantly reduced overall efficacy and the accuracy of rule-in. Alternative slightly higher cut-off concentrations may be considered for older patients, particularly if using hs-cTnI.Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT00470587, number NCT00470587 and NCT02355457 (BACC).
KW - Adult
KW - Age Factors
KW - Aged
KW - Algorithms
KW - Early Diagnosis
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/diagnosis
KW - Practice Guidelines as Topic
KW - Prospective Studies
KW - Sensitivity and Specificity
KW - Troponin/blood
U2 - 10.1093/eurheartj/ehy514
DO - 10.1093/eurheartj/ehy514
M3 - SCORING: Journal article
C2 - 30169752
VL - 39
SP - 3780
EP - 3794
JO - EUR HEART J
JF - EUR HEART J
SN - 0195-668X
IS - 42
ER -