Safety and efficacy of the 0 h/3 h protocol for rapid rule out of myocardial infarction
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Safety and efficacy of the 0 h/3 h protocol for rapid rule out of myocardial infarction. / Wildi, Karin; Nelles, Berit; Twerenbold, Raphael; Rubini Giménez, Maria; Reichlin, Tobias; Singeisen, Hélène; Druey, Sophie; Haaf, Philip; Sabti, Zaid; Hillinger, Petra; Jaeger, Cedric; Campodarve, Isabel; Kreutzinger, Philip; Puelacher, Christian; Moreno Weidmann, Zoraida; Gugala, Mathias; Pretre, Gilles; Doerflinger, Stephanie; Wagener, Max; Stallone, Fabio; Freese, Michael; Stelzig, Claudia; Rentsch, Katharina; Bassetti, Stefano; Bingisser, Roland; Osswald, Stefan; Mueller, Christian.
in: AM HEART J, Jahrgang 181, 11.2016, S. 16-25.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Safety and efficacy of the 0 h/3 h protocol for rapid rule out of myocardial infarction
AU - Wildi, Karin
AU - Nelles, Berit
AU - Twerenbold, Raphael
AU - Rubini Giménez, Maria
AU - Reichlin, Tobias
AU - Singeisen, Hélène
AU - Druey, Sophie
AU - Haaf, Philip
AU - Sabti, Zaid
AU - Hillinger, Petra
AU - Jaeger, Cedric
AU - Campodarve, Isabel
AU - Kreutzinger, Philip
AU - Puelacher, Christian
AU - Moreno Weidmann, Zoraida
AU - Gugala, Mathias
AU - Pretre, Gilles
AU - Doerflinger, Stephanie
AU - Wagener, Max
AU - Stallone, Fabio
AU - Freese, Michael
AU - Stelzig, Claudia
AU - Rentsch, Katharina
AU - Bassetti, Stefano
AU - Bingisser, Roland
AU - Osswald, Stefan
AU - Mueller, Christian
N1 - Copyright © 2016 Elsevier Inc. All rights reserved.
PY - 2016/11
Y1 - 2016/11
N2 - BACKGROUND: The early and accurate diagnosis of acute myocardial infarction (AMI) is an important medical and economic challenge. We aimed to prospectively evaluate the performance of the new European Society of Cardiology rapid 0-hour/3-hour (0 h/3 h) rule out protocol for AMI.METHODS: We enrolled 2,727 consecutive patients presenting with suspected AMI without persistent ST-segment elevation to the emergency department in a prospective international multicenter study. The final diagnosis was adjudicated by 2 independent cardiologists. The performance of the 0 h/3 h rule out protocol was evaluated using 4 high-sensitivity (primary analysis) and 3 sensitive cardiac troponin (cTn) assays.RESULTS: Acute myocardial infarction was the final diagnosis in 473 patients (17.3%). Using the 4 high-sensitivity cTn assays, the 0-hour rule out protocol correctly ruled out 99.8% (95% [confidence interval] CI, 98.7%-100%), 99.6% (95% CI, 98.5%-99.9%), 100% (95% CI, 97.9%-100%), and 100% (95% CI, 98.0%-100%) of late presenters (>6 h from chest pain onset). The 3-hour rule out protocol correctly ruled out 99.9% (95% CI, 99.1%-100%), 99.5% (95% CI, 98.3%-99.9%), 100% (95% CI, 98.1%-100%), and 100% (95% CI, 98.2%-100%) of early presenters (<6 h from chest pain onset). Using the 3 sensitive cTn assays, the 0-hour rule out protocol correctly ruled out 99.6% (95% CI, 98.6%-99.9%), 99.0% (95% CI, 96.9%-99.7%), and 99.1% (95% CI, 97.2%-99.8%) of late presenters; and the 3-hour rule out protocol correctly ruled out 99.4% (95% CI, 98.3%-99.8%), 99.2% (95% CI, 97.3%-99.8%), and 99.0% (95% CI, 97.2%-99.7%) of early presenters. Overall, the 0 h/3 h rule out protocol assigned 40% to 60% of patients to rule out. None of the patients assigned rule out died during 3-months follow-up.CONCLUSIONS: The 0 h/3 h rule out protocol seems to allow the accurate rule out of AMI using both high-sensitivity and sensitive cTn measurements in conjunction with clinical assessment. Additional studies are warranted for external validation.
AB - BACKGROUND: The early and accurate diagnosis of acute myocardial infarction (AMI) is an important medical and economic challenge. We aimed to prospectively evaluate the performance of the new European Society of Cardiology rapid 0-hour/3-hour (0 h/3 h) rule out protocol for AMI.METHODS: We enrolled 2,727 consecutive patients presenting with suspected AMI without persistent ST-segment elevation to the emergency department in a prospective international multicenter study. The final diagnosis was adjudicated by 2 independent cardiologists. The performance of the 0 h/3 h rule out protocol was evaluated using 4 high-sensitivity (primary analysis) and 3 sensitive cardiac troponin (cTn) assays.RESULTS: Acute myocardial infarction was the final diagnosis in 473 patients (17.3%). Using the 4 high-sensitivity cTn assays, the 0-hour rule out protocol correctly ruled out 99.8% (95% [confidence interval] CI, 98.7%-100%), 99.6% (95% CI, 98.5%-99.9%), 100% (95% CI, 97.9%-100%), and 100% (95% CI, 98.0%-100%) of late presenters (>6 h from chest pain onset). The 3-hour rule out protocol correctly ruled out 99.9% (95% CI, 99.1%-100%), 99.5% (95% CI, 98.3%-99.9%), 100% (95% CI, 98.1%-100%), and 100% (95% CI, 98.2%-100%) of early presenters (<6 h from chest pain onset). Using the 3 sensitive cTn assays, the 0-hour rule out protocol correctly ruled out 99.6% (95% CI, 98.6%-99.9%), 99.0% (95% CI, 96.9%-99.7%), and 99.1% (95% CI, 97.2%-99.8%) of late presenters; and the 3-hour rule out protocol correctly ruled out 99.4% (95% CI, 98.3%-99.8%), 99.2% (95% CI, 97.3%-99.8%), and 99.0% (95% CI, 97.2%-99.7%) of early presenters. Overall, the 0 h/3 h rule out protocol assigned 40% to 60% of patients to rule out. None of the patients assigned rule out died during 3-months follow-up.CONCLUSIONS: The 0 h/3 h rule out protocol seems to allow the accurate rule out of AMI using both high-sensitivity and sensitive cTn measurements in conjunction with clinical assessment. Additional studies are warranted for external validation.
KW - Aged
KW - Aged, 80 and over
KW - Chest Pain/blood
KW - Clinical Protocols
KW - Electrocardiography
KW - Emergency Service, Hospital
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/blood
KW - Prospective Studies
KW - Time Factors
KW - Troponin I/blood
KW - Troponin T/blood
U2 - 10.1016/j.ahj.2016.07.013
DO - 10.1016/j.ahj.2016.07.013
M3 - SCORING: Journal article
C2 - 27823689
VL - 181
SP - 16
EP - 25
JO - AM HEART J
JF - AM HEART J
SN - 0002-8703
ER -