Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction
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Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction. / Twerenbold, Raphael; Neumann, Johannes Tobias; Sörensen, Nils Arne; Ojeda, Francisco; Karakas, Mahir; Boeddinghaus, Jasper; Nestelberger, Thomas; Badertscher, Patrick; Rubini Giménez, Maria; Puelacher, Christian; Wildi, Karin; Kozhuharov, Nikola; Breitenbuecher, Dominik; Biskup, Ewelina; du Fay de Lavallaz, Jeanne; Flores, Dayana; Wussler, Desiree; Miró, Òscar; Martín Sánchez, F Javier; Morawiec, Beata; Parenica, Jiri; Geigy, Nicolas; Keller, Dagmar I; Zeller, Tanja; Reichlin, Tobias; Blankenberg, Stefan; Westermann, Dirk; Mueller, Christian.
in: J AM COLL CARDIOL, Jahrgang 72, Nr. 6, 07.08.2018, S. 620-632.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction
AU - Twerenbold, Raphael
AU - Neumann, Johannes Tobias
AU - Sörensen, Nils Arne
AU - Ojeda, Francisco
AU - Karakas, Mahir
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - Badertscher, Patrick
AU - Rubini Giménez, Maria
AU - Puelacher, Christian
AU - Wildi, Karin
AU - Kozhuharov, Nikola
AU - Breitenbuecher, Dominik
AU - Biskup, Ewelina
AU - du Fay de Lavallaz, Jeanne
AU - Flores, Dayana
AU - Wussler, Desiree
AU - Miró, Òscar
AU - Martín Sánchez, F Javier
AU - Morawiec, Beata
AU - Parenica, Jiri
AU - Geigy, Nicolas
AU - Keller, Dagmar I
AU - Zeller, Tanja
AU - Reichlin, Tobias
AU - Blankenberg, Stefan
AU - Westermann, Dirk
AU - Mueller, Christian
N1 - Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2018/8/7
Y1 - 2018/8/7
N2 - BACKGROUND: The safety of the European Society of Cardiology (ESC) 0/1-h algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin (hs-cTn) has been questioned.OBJECTIVES: This study aimed to validate the diagnostic performance of the 0/1-h algorithm in a large multicenter study.METHODS: The authors prospectively enrolled unselected patients in 6 countries presenting to the emergency department with symptoms suggestive of NSTEMI. Final diagnosis was centrally adjudicated by 2 independent cardiologists. Hs-cTnT and hs-cTnI blood concentrations were measured at presentation and after 1 h. Safety of rule-out was quantified by the negative predictive value (NPV) for NSTEMI, accuracy of rule-in by the positive predictive value (PPV), and overall efficacy by the proportion of patients triaged towards rule-out or rule-in within 1 h.RESULTS: Prevalence of NSTEMI was 17%. Among 4,368 patients with serial hs-cTnT measurements available, safety of rule-out (NPV 99.8%, 2,488 of 2,493), accuracy of rule-in (PPV 74.5%, 572 of 768), and overall efficacy were high by assigning three-fourths of patients either to rule-out (57%, 2,493 to 4,368) or rule-in (18%, 768 to 4,368). Similarly, among 3,500 patients with serial hs-cTnI measurements, safety of rule-out (NPV 99.7%, 1,528 of 1,533), accuracy of rule-in (PPV 62.3%, 498 of 800), and overall efficacy were high by assigning more than two-thirds of patients either to rule-out (44%, 1,533 of 3,500) or rule-in (23%, 800 of 3,500). Excellent safety was confirmed in multiple subgroup analyses including patients presenting early (≤3 h) after chest pain onset.CONCLUSIONS: The ESC 0/1-h algorithm using hs-cTnT and hs-cTnI is very safe and effective in triaging patients with suspected NSTEMI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE]; NCT00470587; and Biomarkers in Acute Cardiac Care [BACC]; NCT02355457).
AB - BACKGROUND: The safety of the European Society of Cardiology (ESC) 0/1-h algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin (hs-cTn) has been questioned.OBJECTIVES: This study aimed to validate the diagnostic performance of the 0/1-h algorithm in a large multicenter study.METHODS: The authors prospectively enrolled unselected patients in 6 countries presenting to the emergency department with symptoms suggestive of NSTEMI. Final diagnosis was centrally adjudicated by 2 independent cardiologists. Hs-cTnT and hs-cTnI blood concentrations were measured at presentation and after 1 h. Safety of rule-out was quantified by the negative predictive value (NPV) for NSTEMI, accuracy of rule-in by the positive predictive value (PPV), and overall efficacy by the proportion of patients triaged towards rule-out or rule-in within 1 h.RESULTS: Prevalence of NSTEMI was 17%. Among 4,368 patients with serial hs-cTnT measurements available, safety of rule-out (NPV 99.8%, 2,488 of 2,493), accuracy of rule-in (PPV 74.5%, 572 of 768), and overall efficacy were high by assigning three-fourths of patients either to rule-out (57%, 2,493 to 4,368) or rule-in (18%, 768 to 4,368). Similarly, among 3,500 patients with serial hs-cTnI measurements, safety of rule-out (NPV 99.7%, 1,528 of 1,533), accuracy of rule-in (PPV 62.3%, 498 of 800), and overall efficacy were high by assigning more than two-thirds of patients either to rule-out (44%, 1,533 of 3,500) or rule-in (23%, 800 of 3,500). Excellent safety was confirmed in multiple subgroup analyses including patients presenting early (≤3 h) after chest pain onset.CONCLUSIONS: The ESC 0/1-h algorithm using hs-cTnT and hs-cTnI is very safe and effective in triaging patients with suspected NSTEMI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE]; NCT00470587; and Biomarkers in Acute Cardiac Care [BACC]; NCT02355457).
KW - Aged
KW - Algorithms
KW - Chest Pain/diagnosis
KW - Early Diagnosis
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Internationality
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/diagnosis
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Reproducibility of Results
U2 - 10.1016/j.jacc.2018.05.040
DO - 10.1016/j.jacc.2018.05.040
M3 - SCORING: Journal article
C2 - 30071991
VL - 72
SP - 620
EP - 632
JO - J AM COLL CARDIOL
JF - J AM COLL CARDIOL
SN - 0735-1097
IS - 6
ER -