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Two-Hour Algorithm for Triage toward Rule-Out and Rule-In of Acute Myocardial Infarction by Use of High-Sensitivity Cardiac Troponin I

Standard

Two-Hour Algorithm for Triage toward Rule-Out and Rule-In of Acute Myocardial Infarction by Use of High-Sensitivity Cardiac Troponin I. / Boeddinghaus, Jasper; Reichlin, Tobias; Cullen, Louise; Greenslade, Jaimi H; Parsonage, William A; Hammett, Christopher; Pickering, John W; Hawkins, Tracey; Aldous, Sally; Twerenbold, Raphael; Wildi, Karin; Nestelberger, Thomas; Grimm, Karin; Rubini-Gimenez, Maria; Puelacher, Christian; Kern, Vera; Rentsch, Katharina; Than, Martin; Mueller, Christian.

in: CLIN CHEM, Jahrgang 62, Nr. 3, 03.2016, S. 494-504.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Boeddinghaus, J, Reichlin, T, Cullen, L, Greenslade, JH, Parsonage, WA, Hammett, C, Pickering, JW, Hawkins, T, Aldous, S, Twerenbold, R, Wildi, K, Nestelberger, T, Grimm, K, Rubini-Gimenez, M, Puelacher, C, Kern, V, Rentsch, K, Than, M & Mueller, C 2016, 'Two-Hour Algorithm for Triage toward Rule-Out and Rule-In of Acute Myocardial Infarction by Use of High-Sensitivity Cardiac Troponin I', CLIN CHEM, Jg. 62, Nr. 3, S. 494-504. https://doi.org/10.1373/clinchem.2015.249508

APA

Boeddinghaus, J., Reichlin, T., Cullen, L., Greenslade, J. H., Parsonage, W. A., Hammett, C., Pickering, J. W., Hawkins, T., Aldous, S., Twerenbold, R., Wildi, K., Nestelberger, T., Grimm, K., Rubini-Gimenez, M., Puelacher, C., Kern, V., Rentsch, K., Than, M., & Mueller, C. (2016). Two-Hour Algorithm for Triage toward Rule-Out and Rule-In of Acute Myocardial Infarction by Use of High-Sensitivity Cardiac Troponin I. CLIN CHEM, 62(3), 494-504. https://doi.org/10.1373/clinchem.2015.249508

Vancouver

Boeddinghaus J, Reichlin T, Cullen L, Greenslade JH, Parsonage WA, Hammett C et al. Two-Hour Algorithm for Triage toward Rule-Out and Rule-In of Acute Myocardial Infarction by Use of High-Sensitivity Cardiac Troponin I. CLIN CHEM. 2016 Mär;62(3):494-504. https://doi.org/10.1373/clinchem.2015.249508

Bibtex

@article{6bc7389b16104547a14969d238d55543,
title = "Two-Hour Algorithm for Triage toward Rule-Out and Rule-In of Acute Myocardial Infarction by Use of High-Sensitivity Cardiac Troponin I",
abstract = "BACKGROUND: The early triage of patients toward rule-out and rule-in of acute myocardial infarction (AMI) is challenging. Therefore, we aimed to develop a 2-h algorithm that uses high-sensitivity cardiac troponin I (hs-cTnI).METHODS: We prospectively enrolled 1435 (derivation cohort) and 1194 (external validation cohort) patients presenting with suspected AMI to the emergency department. The final diagnosis was adjudicated by 2 independent cardiologists. hs-cTnI was measured at presentation and after 2 h in a blinded fashion. We derived and validated a diagnostic algorithm incorporating hs-cTnI values at presentation and absolute changes within the first 2 h.RESULTS: AMI was the final diagnosis in 17% of patients in the derivation and 13% in the validation cohort. The 2-h algorithm developed in the derivation cohort classified 56% of patients as rule-out, 17% as rule-in, and 27% as observation. Resulting diagnostic sensitivity and negative predictive value (NPV) were 99.2% and 99.8% for rule-out; specificity and positive predictive value (PPV) were 95.2% and 75.8% for rule-in. Applying the 2-h algorithm in the external validation cohort, 60% of patients were classified as rule-out, 13% as rule-in, and 27% as observation. Diagnostic sensitivity and NPV were 98.7% and 99.7% for rule-out; specificity and PPV were 97.4% and 82.2% for rule-in. Thirty-day survival was 100% for rule-out patients in both cohorts.CONCLUSIONS: A simple algorithm incorporating hs-cTnI baseline values and absolute 2-h changes allowed a triage toward safe rule-out or accurate rule-in of AMI in the majority of patients.",
keywords = "Algorithms, Female, Humans, Limit of Detection, Male, Middle Aged, Myocardial Infarction/blood, Predictive Value of Tests, Prospective Studies, Time Factors, Troponin I/blood",
author = "Jasper Boeddinghaus and Tobias Reichlin and Louise Cullen and Greenslade, {Jaimi H} and Parsonage, {William A} and Christopher Hammett and Pickering, {John W} and Tracey Hawkins and Sally Aldous and Raphael Twerenbold and Karin Wildi and Thomas Nestelberger and Karin Grimm and Maria Rubini-Gimenez and Christian Puelacher and Vera Kern and Katharina Rentsch and Martin Than and Christian Mueller",
note = "{\textcopyright} 2015 American Association for Clinical Chemistry.",
year = "2016",
month = mar,
doi = "10.1373/clinchem.2015.249508",
language = "English",
volume = "62",
pages = "494--504",
journal = "CLIN CHEM",
issn = "0009-9147",
publisher = "American Association for Clinical Chemistry Inc.",
number = "3",

}

RIS

TY - JOUR

T1 - Two-Hour Algorithm for Triage toward Rule-Out and Rule-In of Acute Myocardial Infarction by Use of High-Sensitivity Cardiac Troponin I

AU - Boeddinghaus, Jasper

AU - Reichlin, Tobias

AU - Cullen, Louise

AU - Greenslade, Jaimi H

AU - Parsonage, William A

AU - Hammett, Christopher

AU - Pickering, John W

AU - Hawkins, Tracey

AU - Aldous, Sally

AU - Twerenbold, Raphael

AU - Wildi, Karin

AU - Nestelberger, Thomas

AU - Grimm, Karin

AU - Rubini-Gimenez, Maria

AU - Puelacher, Christian

AU - Kern, Vera

AU - Rentsch, Katharina

AU - Than, Martin

AU - Mueller, Christian

N1 - © 2015 American Association for Clinical Chemistry.

PY - 2016/3

Y1 - 2016/3

N2 - BACKGROUND: The early triage of patients toward rule-out and rule-in of acute myocardial infarction (AMI) is challenging. Therefore, we aimed to develop a 2-h algorithm that uses high-sensitivity cardiac troponin I (hs-cTnI).METHODS: We prospectively enrolled 1435 (derivation cohort) and 1194 (external validation cohort) patients presenting with suspected AMI to the emergency department. The final diagnosis was adjudicated by 2 independent cardiologists. hs-cTnI was measured at presentation and after 2 h in a blinded fashion. We derived and validated a diagnostic algorithm incorporating hs-cTnI values at presentation and absolute changes within the first 2 h.RESULTS: AMI was the final diagnosis in 17% of patients in the derivation and 13% in the validation cohort. The 2-h algorithm developed in the derivation cohort classified 56% of patients as rule-out, 17% as rule-in, and 27% as observation. Resulting diagnostic sensitivity and negative predictive value (NPV) were 99.2% and 99.8% for rule-out; specificity and positive predictive value (PPV) were 95.2% and 75.8% for rule-in. Applying the 2-h algorithm in the external validation cohort, 60% of patients were classified as rule-out, 13% as rule-in, and 27% as observation. Diagnostic sensitivity and NPV were 98.7% and 99.7% for rule-out; specificity and PPV were 97.4% and 82.2% for rule-in. Thirty-day survival was 100% for rule-out patients in both cohorts.CONCLUSIONS: A simple algorithm incorporating hs-cTnI baseline values and absolute 2-h changes allowed a triage toward safe rule-out or accurate rule-in of AMI in the majority of patients.

AB - BACKGROUND: The early triage of patients toward rule-out and rule-in of acute myocardial infarction (AMI) is challenging. Therefore, we aimed to develop a 2-h algorithm that uses high-sensitivity cardiac troponin I (hs-cTnI).METHODS: We prospectively enrolled 1435 (derivation cohort) and 1194 (external validation cohort) patients presenting with suspected AMI to the emergency department. The final diagnosis was adjudicated by 2 independent cardiologists. hs-cTnI was measured at presentation and after 2 h in a blinded fashion. We derived and validated a diagnostic algorithm incorporating hs-cTnI values at presentation and absolute changes within the first 2 h.RESULTS: AMI was the final diagnosis in 17% of patients in the derivation and 13% in the validation cohort. The 2-h algorithm developed in the derivation cohort classified 56% of patients as rule-out, 17% as rule-in, and 27% as observation. Resulting diagnostic sensitivity and negative predictive value (NPV) were 99.2% and 99.8% for rule-out; specificity and positive predictive value (PPV) were 95.2% and 75.8% for rule-in. Applying the 2-h algorithm in the external validation cohort, 60% of patients were classified as rule-out, 13% as rule-in, and 27% as observation. Diagnostic sensitivity and NPV were 98.7% and 99.7% for rule-out; specificity and PPV were 97.4% and 82.2% for rule-in. Thirty-day survival was 100% for rule-out patients in both cohorts.CONCLUSIONS: A simple algorithm incorporating hs-cTnI baseline values and absolute 2-h changes allowed a triage toward safe rule-out or accurate rule-in of AMI in the majority of patients.

KW - Algorithms

KW - Female

KW - Humans

KW - Limit of Detection

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/blood

KW - Predictive Value of Tests

KW - Prospective Studies

KW - Time Factors

KW - Troponin I/blood

U2 - 10.1373/clinchem.2015.249508

DO - 10.1373/clinchem.2015.249508

M3 - SCORING: Journal article

C2 - 26797687

VL - 62

SP - 494

EP - 504

JO - CLIN CHEM

JF - CLIN CHEM

SN - 0009-9147

IS - 3

ER -