Predicting Acute Myocardial Infarction with a Single Blood Draw
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Predicting Acute Myocardial Infarction with a Single Blood Draw. / APACE Investigators.
in: CLIN CHEM, Jahrgang 65, Nr. 3, 03.2019, S. 437-450.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Predicting Acute Myocardial Infarction with a Single Blood Draw
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - Badertscher, Patrick
AU - Twerenbold, Raphael
AU - Fitze, Brigitte
AU - Wussler, Desiree
AU - Strebel, Ivo
AU - Rubini Giménez, Maria
AU - Wildi, Karin
AU - Puelacher, Christian
AU - du Fay de Lavallaz, Jeanne
AU - Oehen, Loris
AU - Walter, Joan
AU - Miró, Òscar
AU - Martin-Sanchez, F Javier
AU - Morawiec, Beata
AU - Potlukova, Eliska
AU - Keller, Dagmar I
AU - Reichlin, Tobias
AU - Mueller, Christian
AU - APACE Investigators
N1 - © 2018 American Association for Clinical Chemistry.
PY - 2019/3
Y1 - 2019/3
N2 - BACKGROUND: We desired to determine cardiac troponin (cTn) concentrations necessary to achieve a positive predictive value (PPV) of ≥75% for acute myocardial infarction (AMI) to justify immediate admission of patients to a monitored unit and, in general, early coronary angiography.METHODS: In a prospective multicenter diagnostic study enrolling patients presenting to the emergency department with symptoms suggestive of AMI, final diagnoses were adjudicated by 2 independent cardiologists based on clinical information including cardiac imaging. cTn concentrations were measured using 5 different sensitive and high-sensitivity cTn (hs-cTn) assays in a blinded fashion at presentation and serially thereafter. The diagnostic end point was PPV for rule-in of AMI of initial cTn concentrations alone and in combination with early changes.RESULTS: Among 3828 patients, 616 (16%) had an AMI. At presentation, 7% to 14% of patients had cTnT/I concentrations associated with a PPV of ≥75%. Adding absolute or relative changes did not significantly further increase the PPV. PPVs increased from 46.5% (95% CI, 43.6-49.4) for hs-cTnT at presentation >14 ng/L to 78.9% (95% CI, 74.7-82.5) for >52 ng/L (P < 0.001), whereas PPVs in higher hs-cTnT strata remained largely unchanged [e.g., 82.4% (95% CI, 77.5-86.7) for >80 ng/L vs 83.9% (95% CI, 76.0-90.1) for >200 ng/L (P = 0.72)]. The addition of early changes in hs-cTnT further increased the PPV up to 60 ng/L, but not for higher concentrations.CONCLUSIONS: Serial sampling does not seem necessary for predicting AMI and concurrent decision-making in about 10% of patients, as it only marginally increases the PPV for AMI and not in a statistically or clinically significant way.CLINICALTRIALSGOV IDENTIFIER: NCT00470587.
AB - BACKGROUND: We desired to determine cardiac troponin (cTn) concentrations necessary to achieve a positive predictive value (PPV) of ≥75% for acute myocardial infarction (AMI) to justify immediate admission of patients to a monitored unit and, in general, early coronary angiography.METHODS: In a prospective multicenter diagnostic study enrolling patients presenting to the emergency department with symptoms suggestive of AMI, final diagnoses were adjudicated by 2 independent cardiologists based on clinical information including cardiac imaging. cTn concentrations were measured using 5 different sensitive and high-sensitivity cTn (hs-cTn) assays in a blinded fashion at presentation and serially thereafter. The diagnostic end point was PPV for rule-in of AMI of initial cTn concentrations alone and in combination with early changes.RESULTS: Among 3828 patients, 616 (16%) had an AMI. At presentation, 7% to 14% of patients had cTnT/I concentrations associated with a PPV of ≥75%. Adding absolute or relative changes did not significantly further increase the PPV. PPVs increased from 46.5% (95% CI, 43.6-49.4) for hs-cTnT at presentation >14 ng/L to 78.9% (95% CI, 74.7-82.5) for >52 ng/L (P < 0.001), whereas PPVs in higher hs-cTnT strata remained largely unchanged [e.g., 82.4% (95% CI, 77.5-86.7) for >80 ng/L vs 83.9% (95% CI, 76.0-90.1) for >200 ng/L (P = 0.72)]. The addition of early changes in hs-cTnT further increased the PPV up to 60 ng/L, but not for higher concentrations.CONCLUSIONS: Serial sampling does not seem necessary for predicting AMI and concurrent decision-making in about 10% of patients, as it only marginally increases the PPV for AMI and not in a statistically or clinically significant way.CLINICALTRIALSGOV IDENTIFIER: NCT00470587.
KW - Acute Disease
KW - Aged
KW - Aged, 80 and over
KW - Biomarkers/blood
KW - Blood Chemical Analysis/methods
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/diagnosis
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Troponin I/blood
KW - Troponin T/blood
U2 - 10.1373/clinchem.2018.294124
DO - 10.1373/clinchem.2018.294124
M3 - SCORING: Journal article
C2 - 30626633
VL - 65
SP - 437
EP - 450
JO - CLIN CHEM
JF - CLIN CHEM
SN - 0009-9147
IS - 3
ER -