Performance of the ESC 0/1-h and 0/3-h Algorithm for the Rapid Identification of Myocardial Infarction Without ST-Elevation in Patients With Diabetes
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Performance of the ESC 0/1-h and 0/3-h Algorithm for the Rapid Identification of Myocardial Infarction Without ST-Elevation in Patients With Diabetes. / Haller, Paul M; Boeddinghaus, Jasper; Neumann, Johannes T; Sörensen, Nils A; Hartikainen, Tau S; Goßling, Alina; Nestelberger, Thomas; Twerenbold, Raphael; Lehmacher, Jonas; Keller, Till; Zeller, Tanja; Blankenberg, Stefan; Mueller, Christian; Westermann, Dirk.
in: DIABETES CARE, Jahrgang 43, Nr. 2, 02.2020, S. 460-467.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Performance of the ESC 0/1-h and 0/3-h Algorithm for the Rapid Identification of Myocardial Infarction Without ST-Elevation in Patients With Diabetes
AU - Haller, Paul M
AU - Boeddinghaus, Jasper
AU - Neumann, Johannes T
AU - Sörensen, Nils A
AU - Hartikainen, Tau S
AU - Goßling, Alina
AU - Nestelberger, Thomas
AU - Twerenbold, Raphael
AU - Lehmacher, Jonas
AU - Keller, Till
AU - Zeller, Tanja
AU - Blankenberg, Stefan
AU - Mueller, Christian
AU - Westermann, Dirk
N1 - © 2019 by the American Diabetes Association.
PY - 2020/2
Y1 - 2020/2
N2 - OBJECTIVE: Patients with diabetes mellitus (DM) have elevated levels of high-sensitivity cardiac troponin (hs-cTn). We investigated the diagnostic performance of the European Society of Cardiology (ESC) algorithms to rule out or rule in acute myocardial infarction (AMI) without ST-elevation in patients with DM.RESEARCH DESIGN AND METHODS: We prospectively enrolled 3,681 patients with suspected AMI and stratified those by the presence of DM. The ESC 0/1-h and 0/3-h algorithms were used to calculate negative and positive predictive values (NPV, PPV). In addition, alternative cutoffs were calculated and externally validated in 2,895 patients.RESULTS: In total, 563 patients (15.3%) had DM, and 137 (24.3%) of these had AMI. When the ESC 0/1-h algorithm was used, the NPV was comparable in patients with and without DM (absolute difference [AD] -1.50 [95% CI -5.95, 2.96]). In contrast, the ESC 0/3-h algorithm resulted in a significantly lower NPV in patients with DM (AD -2.27 [95% CI -4.47, -0.07]). The diagnostic performance for rule-in of AMI (PPV) was comparable in both groups: 0/1-h (AD 6.59 [95% CI -19.53, 6.35]) and 0/3-h (AD 1.03 [95% CI -7.63, 9.7]). Alternative cutoffs increased the PPV in both algorithms significantly, while improvements in NPV were only subtle.CONCLUSIONS: Application of the ESC 0/1-h algorithm revealed comparable safety to rule out AMI comparing patients with and without DM, while this was not observed with the ESC 0/3-h algorithm. Although alternative cutoffs might be helpful, patients with DM remain a high-risk population in whom identification of AMI is challenging and who require careful clinical evaluation.
AB - OBJECTIVE: Patients with diabetes mellitus (DM) have elevated levels of high-sensitivity cardiac troponin (hs-cTn). We investigated the diagnostic performance of the European Society of Cardiology (ESC) algorithms to rule out or rule in acute myocardial infarction (AMI) without ST-elevation in patients with DM.RESEARCH DESIGN AND METHODS: We prospectively enrolled 3,681 patients with suspected AMI and stratified those by the presence of DM. The ESC 0/1-h and 0/3-h algorithms were used to calculate negative and positive predictive values (NPV, PPV). In addition, alternative cutoffs were calculated and externally validated in 2,895 patients.RESULTS: In total, 563 patients (15.3%) had DM, and 137 (24.3%) of these had AMI. When the ESC 0/1-h algorithm was used, the NPV was comparable in patients with and without DM (absolute difference [AD] -1.50 [95% CI -5.95, 2.96]). In contrast, the ESC 0/3-h algorithm resulted in a significantly lower NPV in patients with DM (AD -2.27 [95% CI -4.47, -0.07]). The diagnostic performance for rule-in of AMI (PPV) was comparable in both groups: 0/1-h (AD 6.59 [95% CI -19.53, 6.35]) and 0/3-h (AD 1.03 [95% CI -7.63, 9.7]). Alternative cutoffs increased the PPV in both algorithms significantly, while improvements in NPV were only subtle.CONCLUSIONS: Application of the ESC 0/1-h algorithm revealed comparable safety to rule out AMI comparing patients with and without DM, while this was not observed with the ESC 0/3-h algorithm. Although alternative cutoffs might be helpful, patients with DM remain a high-risk population in whom identification of AMI is challenging and who require careful clinical evaluation.
KW - Aged
KW - Algorithms
KW - Arrhythmias, Cardiac/complications
KW - Biomarkers/analysis
KW - Cardiology/organization & administration
KW - Cohort Studies
KW - Diabetes Mellitus/blood
KW - Diabetic Angiopathies/diagnosis
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/blood
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Risk Factors
KW - Societies, Medical/standards
KW - Time Factors
KW - Troponin I/analysis
U2 - 10.2337/dc19-1327
DO - 10.2337/dc19-1327
M3 - SCORING: Journal article
C2 - 31843947
VL - 43
SP - 460
EP - 467
JO - DIABETES CARE
JF - DIABETES CARE
SN - 0149-5992
IS - 2
ER -