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Using High-Sensitivity Cardiac Troponin for the Exclusion of Inducible Myocardial Ischemia in Symptomatic Patients: A Cohort Study.

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Using High-Sensitivity Cardiac Troponin for the Exclusion of Inducible Myocardial Ischemia in Symptomatic Patients: A Cohort Study. / Walter, J; du, Fay de Lavallaz J; Koechlin, L; Zimmermann, T; Boeddinghaus, J; Honegger, U; Strebel, I; Twerenbold, R; Amrein, M; Nestelberger, T; Wussler, D; Mueller, C.

in: ANN INTERN MED, Jahrgang 172, Nr. 3, 01.2020, S. 175-185.

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

Harvard

Walter, J, du, FDLJ, Koechlin, L, Zimmermann, T, Boeddinghaus, J, Honegger, U, Strebel, I, Twerenbold, R, Amrein, M, Nestelberger, T, Wussler, D & Mueller, C 2020, 'Using High-Sensitivity Cardiac Troponin for the Exclusion of Inducible Myocardial Ischemia in Symptomatic Patients: A Cohort Study.', ANN INTERN MED, Jg. 172, Nr. 3, S. 175-185. https://doi.org/10.7326/m19-0080

APA

Walter, J., du, F. D. L. J., Koechlin, L., Zimmermann, T., Boeddinghaus, J., Honegger, U., Strebel, I., Twerenbold, R., Amrein, M., Nestelberger, T., Wussler, D., & Mueller, C. (2020). Using High-Sensitivity Cardiac Troponin for the Exclusion of Inducible Myocardial Ischemia in Symptomatic Patients: A Cohort Study. ANN INTERN MED, 172(3), 175-185. https://doi.org/10.7326/m19-0080

Vancouver

Walter J, du FDLJ, Koechlin L, Zimmermann T, Boeddinghaus J, Honegger U et al. Using High-Sensitivity Cardiac Troponin for the Exclusion of Inducible Myocardial Ischemia in Symptomatic Patients: A Cohort Study. ANN INTERN MED. 2020 Jan;172(3):175-185. https://doi.org/10.7326/m19-0080

Bibtex

@article{fdde03cd6b184912af9af57b6e75afa9,
title = "Using High-Sensitivity Cardiac Troponin for the Exclusion of Inducible Myocardial Ischemia in Symptomatic Patients: A Cohort Study.",
abstract = "Background:The optimal noninvasive method for surveillance in symptomatic patients with stable coronary artery disease (CAD) is unknown.Objective:To apply a novel approach using very low concentrations of high-sensitivity cardiac troponin I (hs-cTnI) for exclusion of inducible myocardial ischemia in symptomatic patients with CAD.Design:Prospective diagnostic cohort study. (ClinicalTrials.gov: NCT01838148)Setting:University hospital.Patients:1896 consecutive patients with CAD referred with symptoms possibly related to inducible myocardial ischemia.Measurements:Presence of inducible myocardial ischemia was adjudicated using myocardial perfusion imaging with single-photon emission computed tomography, as well as coronary angiography and fractional flow reserve measurements where available. Staff blinded to adjudication measured circulating hs-cTn concentrations. An hs-cTnI cutoff of 2.5 ng/L, derived previously in mostly asymptomatic patients with CAD, was assessed. Predefined target performance criteria were at least 90% negative predictive value (NPV) and at least 90% sensitivity for exclusion of inducible myocardial ischemia. Sensitivity analyses were based on measurements with an hs-cTnT assay and an alternative hs-cTnI assay with even higher analytic sensitivity (limit of detection, 0.1 ng/L).Results:Overall, 865 patients (46%) had inducible myocardial ischemia. The hs-cTnI cutoff of 2.5 ng/L provided an NPV of 70% (95% CI, 64% to 75%) and a sensitivity of 90% (CI, 88% to 92%) for exclusion of inducible myocardial ischemia. No hs-cTnI cutoff reached both performance characteristics predefined as targets. Similarly, using the alternative assays for hs-cTnI or hs-cTnT, no cutoff achieved the target performance: hs-cTnT concentrations less than 5 ng/L yielded an NPV of 66% (CI, 59% to 72%), and hs-cTnI concentrations less than 2 ng/L yielded an NPV of 68% (CI, 62% to 74%).",
author = "J Walter and du, {Fay de Lavallaz J} and L Koechlin and T Zimmermann and J Boeddinghaus and U Honegger and I Strebel and R Twerenbold and M Amrein and T Nestelberger and D Wussler and C Mueller",
year = "2020",
month = jan,
doi = "10.7326/m19-0080",
language = "English",
volume = "172",
pages = "175--185",
journal = "ANN INTERN MED",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "3",

}

RIS

TY - JOUR

T1 - Using High-Sensitivity Cardiac Troponin for the Exclusion of Inducible Myocardial Ischemia in Symptomatic Patients: A Cohort Study.

AU - Walter, J

AU - du, Fay de Lavallaz J

AU - Koechlin, L

AU - Zimmermann, T

AU - Boeddinghaus, J

AU - Honegger, U

AU - Strebel, I

AU - Twerenbold, R

AU - Amrein, M

AU - Nestelberger, T

AU - Wussler, D

AU - Mueller, C

PY - 2020/1

Y1 - 2020/1

N2 - Background:The optimal noninvasive method for surveillance in symptomatic patients with stable coronary artery disease (CAD) is unknown.Objective:To apply a novel approach using very low concentrations of high-sensitivity cardiac troponin I (hs-cTnI) for exclusion of inducible myocardial ischemia in symptomatic patients with CAD.Design:Prospective diagnostic cohort study. (ClinicalTrials.gov: NCT01838148)Setting:University hospital.Patients:1896 consecutive patients with CAD referred with symptoms possibly related to inducible myocardial ischemia.Measurements:Presence of inducible myocardial ischemia was adjudicated using myocardial perfusion imaging with single-photon emission computed tomography, as well as coronary angiography and fractional flow reserve measurements where available. Staff blinded to adjudication measured circulating hs-cTn concentrations. An hs-cTnI cutoff of 2.5 ng/L, derived previously in mostly asymptomatic patients with CAD, was assessed. Predefined target performance criteria were at least 90% negative predictive value (NPV) and at least 90% sensitivity for exclusion of inducible myocardial ischemia. Sensitivity analyses were based on measurements with an hs-cTnT assay and an alternative hs-cTnI assay with even higher analytic sensitivity (limit of detection, 0.1 ng/L).Results:Overall, 865 patients (46%) had inducible myocardial ischemia. The hs-cTnI cutoff of 2.5 ng/L provided an NPV of 70% (95% CI, 64% to 75%) and a sensitivity of 90% (CI, 88% to 92%) for exclusion of inducible myocardial ischemia. No hs-cTnI cutoff reached both performance characteristics predefined as targets. Similarly, using the alternative assays for hs-cTnI or hs-cTnT, no cutoff achieved the target performance: hs-cTnT concentrations less than 5 ng/L yielded an NPV of 66% (CI, 59% to 72%), and hs-cTnI concentrations less than 2 ng/L yielded an NPV of 68% (CI, 62% to 74%).

AB - Background:The optimal noninvasive method for surveillance in symptomatic patients with stable coronary artery disease (CAD) is unknown.Objective:To apply a novel approach using very low concentrations of high-sensitivity cardiac troponin I (hs-cTnI) for exclusion of inducible myocardial ischemia in symptomatic patients with CAD.Design:Prospective diagnostic cohort study. (ClinicalTrials.gov: NCT01838148)Setting:University hospital.Patients:1896 consecutive patients with CAD referred with symptoms possibly related to inducible myocardial ischemia.Measurements:Presence of inducible myocardial ischemia was adjudicated using myocardial perfusion imaging with single-photon emission computed tomography, as well as coronary angiography and fractional flow reserve measurements where available. Staff blinded to adjudication measured circulating hs-cTn concentrations. An hs-cTnI cutoff of 2.5 ng/L, derived previously in mostly asymptomatic patients with CAD, was assessed. Predefined target performance criteria were at least 90% negative predictive value (NPV) and at least 90% sensitivity for exclusion of inducible myocardial ischemia. Sensitivity analyses were based on measurements with an hs-cTnT assay and an alternative hs-cTnI assay with even higher analytic sensitivity (limit of detection, 0.1 ng/L).Results:Overall, 865 patients (46%) had inducible myocardial ischemia. The hs-cTnI cutoff of 2.5 ng/L provided an NPV of 70% (95% CI, 64% to 75%) and a sensitivity of 90% (CI, 88% to 92%) for exclusion of inducible myocardial ischemia. No hs-cTnI cutoff reached both performance characteristics predefined as targets. Similarly, using the alternative assays for hs-cTnI or hs-cTnT, no cutoff achieved the target performance: hs-cTnT concentrations less than 5 ng/L yielded an NPV of 66% (CI, 59% to 72%), and hs-cTnI concentrations less than 2 ng/L yielded an NPV of 68% (CI, 62% to 74%).

U2 - 10.7326/m19-0080

DO - 10.7326/m19-0080

M3 - SCORING: Journal article

C2 - 31905377

VL - 172

SP - 175

EP - 185

JO - ANN INTERN MED

JF - ANN INTERN MED

SN - 0003-4819

IS - 3

ER -