Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay

TY - JOUR

T1 - Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay

AU - Reichlin, Tobias

AU - Twerenbold, Raphael

AU - Wildi, Karin

AU - Rubini Gimenez, Maria

AU - Bergsma, Nathalie

AU - Haaf, Philip

AU - Druey, Sophie

AU - Puelacher, Christian

AU - Moehring, Berit

AU - Freese, Michael

AU - Stelzig, Claudia

AU - Krivoshei, Lian

AU - Hillinger, Petra

AU - Jäger, Cedric

AU - Herrmann, Thomas

AU - Kreutzinger, Philip

AU - Radosavac, Milos

AU - Weidmann, Zoraida M.oreno

AU - Pershyna, Kateryna

AU - Honegger, Ursina

AU - Wagener, Max

AU - Vuillomenet, Thierry

AU - Campodarve, Isabel

AU - Bingisser, Roland

AU - Miró, Òscar

AU - Rentsch, Katharina

AU - Bassetti, Stefano

AU - Osswald, Stefan

AU - Mueller, Christian

N1 - Publisher Copyright: © 2015 Canadian Medical Association or its licensors.

PY - 2015/5/19

Y1 - 2015/5/19

N2 - BACKGROUND: We aimed to prospectively validate a novel 1-hour algorithm using high-sensitivity cardiac troponin T measurement for early rule-out and rule-in of acute myocardial infarction (MI).METHODS: In a multicentre study, we enrolled 1320 patients presenting to the emergency department with suspected acute MI. The high-sensitivity cardiac troponin T 1-hour algorithm, incorporating baseline values as well as absolute changes within the first hour, was validated against the final diagnosis. The final diagnosis was then adjudicated by 2 independent cardiologists using all available information, including coronary angiography, echocardiography, follow-up data and serial measurements of high-sensitivity cardiac troponin T levels.RESULTS: Acute MI was the final diagnosis in 17.3% of patients. With application of the high-sensitivity cardiac troponin T 1-hour algorithm, 786 (59.5%) patients were classified as "rule-out," 216 (16.4%) were classified as "rule-in" and 318 (24.1%) were classified to the "observational zone." The sensitivity and the negative predictive value for acute MI in the rule-out zone were 99.6% (95% confidence interval [CI] 97.6%-99.9%) and 99.9% (95% CI 99.3%-100%), respectively. The specificity and the positive predictive value for acute MI in the rule-in zone were 95.7% (95% CI 94.3%-96.8%) and 78.2% (95% CI 72.1%-83.6%), respectively. The 1-hour algorithm provided higher negative and positive predictive values than the standard interpretation of highsensitivity cardiac troponin T using a single cut-off level (both p < 0.05). Cumulative 30-day mortality was 0.0%, 1.6% and 1.9% in patients classified in the rule-out, observational and rule-in groups, respectively (p = 0.001).INTERPRETATION: This rapid strategy incorporating high-sensitivity cardiac troponin T baseline values and absolute changes within the first hour substantially accelerated the management of suspected acute MI by allowing safe rule-out as well as accurate rule-in of acute MI in 3 out of 4 patients.TRIAL REGISTRATION: ClinicalTrials.gov, NCT00470587.

AB - BACKGROUND: We aimed to prospectively validate a novel 1-hour algorithm using high-sensitivity cardiac troponin T measurement for early rule-out and rule-in of acute myocardial infarction (MI).METHODS: In a multicentre study, we enrolled 1320 patients presenting to the emergency department with suspected acute MI. The high-sensitivity cardiac troponin T 1-hour algorithm, incorporating baseline values as well as absolute changes within the first hour, was validated against the final diagnosis. The final diagnosis was then adjudicated by 2 independent cardiologists using all available information, including coronary angiography, echocardiography, follow-up data and serial measurements of high-sensitivity cardiac troponin T levels.RESULTS: Acute MI was the final diagnosis in 17.3% of patients. With application of the high-sensitivity cardiac troponin T 1-hour algorithm, 786 (59.5%) patients were classified as "rule-out," 216 (16.4%) were classified as "rule-in" and 318 (24.1%) were classified to the "observational zone." The sensitivity and the negative predictive value for acute MI in the rule-out zone were 99.6% (95% confidence interval [CI] 97.6%-99.9%) and 99.9% (95% CI 99.3%-100%), respectively. The specificity and the positive predictive value for acute MI in the rule-in zone were 95.7% (95% CI 94.3%-96.8%) and 78.2% (95% CI 72.1%-83.6%), respectively. The 1-hour algorithm provided higher negative and positive predictive values than the standard interpretation of highsensitivity cardiac troponin T using a single cut-off level (both p < 0.05). Cumulative 30-day mortality was 0.0%, 1.6% and 1.9% in patients classified in the rule-out, observational and rule-in groups, respectively (p = 0.001).INTERPRETATION: This rapid strategy incorporating high-sensitivity cardiac troponin T baseline values and absolute changes within the first hour substantially accelerated the management of suspected acute MI by allowing safe rule-out as well as accurate rule-in of acute MI in 3 out of 4 patients.TRIAL REGISTRATION: ClinicalTrials.gov, NCT00470587.

UR - http://www.scopus.com/inward/record.url?scp=84964696078&partnerID=8YFLogxK

U2 - 10.1503/cmaj.141349

DO - 10.1503/cmaj.141349

M3 - SCORING: Journal article

C2 - 25869867

AN - SCOPUS:84964696078

VL - 187

SP - E243-E252

JO - CAN MED ASSOC J

JF - CAN MED ASSOC J

SN - 0820-3946

IS - 8

ER -