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Two-hour algorithm for triage toward rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T

Standard

Two-hour algorithm for triage toward rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. / Reichlin, Tobias; Cullen, Louise; Parsonage, William A.; Greenslade, Jaimi; Twerenbold, Raphael; Moehring, Berit; Wildi, Karin; Mueller, Sandra; Zellweger, Christa; Mosimann, Tamina; Rubini Gimenez, Maria; Rentsch, Katharina; Osswald, Stefan; Müller, Christian.

in: AM J MED, Jahrgang 128, Nr. 4, 01.04.2015, S. 369-379.e4.

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

Harvard

Reichlin, T, Cullen, L, Parsonage, WA, Greenslade, J, Twerenbold, R, Moehring, B, Wildi, K, Mueller, S, Zellweger, C, Mosimann, T, Rubini Gimenez, M, Rentsch, K, Osswald, S & Müller, C 2015, 'Two-hour algorithm for triage toward rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T', AM J MED, Jg. 128, Nr. 4, S. 369-379.e4. https://doi.org/10.1016/j.amjmed.2014.10.032

APA

Reichlin, T., Cullen, L., Parsonage, W. A., Greenslade, J., Twerenbold, R., Moehring, B., Wildi, K., Mueller, S., Zellweger, C., Mosimann, T., Rubini Gimenez, M., Rentsch, K., Osswald, S., & Müller, C. (2015). Two-hour algorithm for triage toward rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. AM J MED, 128(4), 369-379.e4. https://doi.org/10.1016/j.amjmed.2014.10.032

Vancouver

Reichlin T, Cullen L, Parsonage WA, Greenslade J, Twerenbold R, Moehring B et al. Two-hour algorithm for triage toward rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. AM J MED. 2015 Apr 1;128(4):369-379.e4. https://doi.org/10.1016/j.amjmed.2014.10.032

Bibtex

@article{5aedaef2fb78459a9ef14d885a14b8af,
title = "Two-hour algorithm for triage toward rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T",
abstract = "Background High-sensitivity cardiac troponin (hs-cTn) may allow an earlier diagnosis of acute myocardial infarction (AMI). Methods We prospectively enrolled 1148 (derivation cohort) and 517 (external validation cohort) unselected patients presenting with suspected AMI to the emergency department. Final diagnosis was adjudicated by 2 independent cardiologists. Hs-cTnT was measured at presentation and after 2 hours. A diagnostic algorithm incorporating hs-cTnT values at presentation and absolute changes within the first 2 hours was derived. Results AMI was the final diagnosis in 16% of patients in the derivation and 9.1% in the validation cohort. The 2-hour algorithm developed in the derivation cohort classified 60% of patients as {"}rule-out,{"} 16% as {"}rule-in,{"} and 24% in the {"}observational-zone.{"} Resulting sensitivity and negative predictive value (NPV) were 99.5% and 99.9%, respectively, for rule-out, and specificity and positive predictive value (PPV) were 96% and 78%, respectively, for rule-in. Applying the 2-hour triage algorithm in the external validation cohort, 78% of patients could be classified as {"}rule-out,{"} 8% as {"}rule-in,{"} and 14% in the {"}observational-zone.{"} Resulting sensitivity and NPV were 96% and 99.5%, respectively, for rule-out, and specificity and PPV were 99% and 85%, respectively, for rule-in. Cumulative 30-day survival rates were 100%, 98.9%, and 95.2% (P <.001), and 100%, 100%, and 95% (P <.001) in patients classified as {"}rule-out,{"} {"}observational-zone,{"} and {"}rule-in{"} in the 2 cohorts, respectively. Conclusions A simple algorithm incorporating hs-cTnT baseline values and absolute changes over 2 hours allowed a triage toward safe rule-out, or accurate rule-in, of AMI in the vast majority of patients, with only 20% requiring more prolonged monitoring and serial blood sampling.",
keywords = "Acute myocardial infarction, Diagnostic algorithm, High-sensitive troponin",
author = "Tobias Reichlin and Louise Cullen and Parsonage, {William A.} and Jaimi Greenslade and Raphael Twerenbold and Berit Moehring and Karin Wildi and Sandra Mueller and Christa Zellweger and Tamina Mosimann and {Rubini Gimenez}, Maria and Katharina Rentsch and Stefan Osswald and Christian M{\"u}ller",
note = "Publisher Copyright: {\textcopyright} 2015 Elsevier Inc. All rights reserved.",
year = "2015",
month = apr,
day = "1",
doi = "10.1016/j.amjmed.2014.10.032",
language = "English",
volume = "128",
pages = "369--379.e4",
journal = "AM J MED",
issn = "0002-9343",
publisher = "Elsevier Inc.",
number = "4",

}

RIS

TY - JOUR

T1 - Two-hour algorithm for triage toward rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T

AU - Reichlin, Tobias

AU - Cullen, Louise

AU - Parsonage, William A.

AU - Greenslade, Jaimi

AU - Twerenbold, Raphael

AU - Moehring, Berit

AU - Wildi, Karin

AU - Mueller, Sandra

AU - Zellweger, Christa

AU - Mosimann, Tamina

AU - Rubini Gimenez, Maria

AU - Rentsch, Katharina

AU - Osswald, Stefan

AU - Müller, Christian

N1 - Publisher Copyright: © 2015 Elsevier Inc. All rights reserved.

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Background High-sensitivity cardiac troponin (hs-cTn) may allow an earlier diagnosis of acute myocardial infarction (AMI). Methods We prospectively enrolled 1148 (derivation cohort) and 517 (external validation cohort) unselected patients presenting with suspected AMI to the emergency department. Final diagnosis was adjudicated by 2 independent cardiologists. Hs-cTnT was measured at presentation and after 2 hours. A diagnostic algorithm incorporating hs-cTnT values at presentation and absolute changes within the first 2 hours was derived. Results AMI was the final diagnosis in 16% of patients in the derivation and 9.1% in the validation cohort. The 2-hour algorithm developed in the derivation cohort classified 60% of patients as "rule-out," 16% as "rule-in," and 24% in the "observational-zone." Resulting sensitivity and negative predictive value (NPV) were 99.5% and 99.9%, respectively, for rule-out, and specificity and positive predictive value (PPV) were 96% and 78%, respectively, for rule-in. Applying the 2-hour triage algorithm in the external validation cohort, 78% of patients could be classified as "rule-out," 8% as "rule-in," and 14% in the "observational-zone." Resulting sensitivity and NPV were 96% and 99.5%, respectively, for rule-out, and specificity and PPV were 99% and 85%, respectively, for rule-in. Cumulative 30-day survival rates were 100%, 98.9%, and 95.2% (P <.001), and 100%, 100%, and 95% (P <.001) in patients classified as "rule-out," "observational-zone," and "rule-in" in the 2 cohorts, respectively. Conclusions A simple algorithm incorporating hs-cTnT baseline values and absolute changes over 2 hours allowed a triage toward safe rule-out, or accurate rule-in, of AMI in the vast majority of patients, with only 20% requiring more prolonged monitoring and serial blood sampling.

AB - Background High-sensitivity cardiac troponin (hs-cTn) may allow an earlier diagnosis of acute myocardial infarction (AMI). Methods We prospectively enrolled 1148 (derivation cohort) and 517 (external validation cohort) unselected patients presenting with suspected AMI to the emergency department. Final diagnosis was adjudicated by 2 independent cardiologists. Hs-cTnT was measured at presentation and after 2 hours. A diagnostic algorithm incorporating hs-cTnT values at presentation and absolute changes within the first 2 hours was derived. Results AMI was the final diagnosis in 16% of patients in the derivation and 9.1% in the validation cohort. The 2-hour algorithm developed in the derivation cohort classified 60% of patients as "rule-out," 16% as "rule-in," and 24% in the "observational-zone." Resulting sensitivity and negative predictive value (NPV) were 99.5% and 99.9%, respectively, for rule-out, and specificity and positive predictive value (PPV) were 96% and 78%, respectively, for rule-in. Applying the 2-hour triage algorithm in the external validation cohort, 78% of patients could be classified as "rule-out," 8% as "rule-in," and 14% in the "observational-zone." Resulting sensitivity and NPV were 96% and 99.5%, respectively, for rule-out, and specificity and PPV were 99% and 85%, respectively, for rule-in. Cumulative 30-day survival rates were 100%, 98.9%, and 95.2% (P <.001), and 100%, 100%, and 95% (P <.001) in patients classified as "rule-out," "observational-zone," and "rule-in" in the 2 cohorts, respectively. Conclusions A simple algorithm incorporating hs-cTnT baseline values and absolute changes over 2 hours allowed a triage toward safe rule-out, or accurate rule-in, of AMI in the vast majority of patients, with only 20% requiring more prolonged monitoring and serial blood sampling.

KW - Acute myocardial infarction

KW - Diagnostic algorithm

KW - High-sensitive troponin

UR - http://www.scopus.com/inward/record.url?scp=84930382031&partnerID=8YFLogxK

U2 - 10.1016/j.amjmed.2014.10.032

DO - 10.1016/j.amjmed.2014.10.032

M3 - SCORING: Journal article

C2 - 25446294

AN - SCOPUS:84930382031

VL - 128

SP - 369-379.e4

JO - AM J MED

JF - AM J MED

SN - 0002-9343

IS - 4

ER -