Characterization of the observe zone of the ESC 2015 high-sensitivity cardiac troponin 0h/1h-algorithm for the early diagnosis of acute myocardial infarction
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Characterization of the observe zone of the ESC 2015 high-sensitivity cardiac troponin 0h/1h-algorithm for the early diagnosis of acute myocardial infarction. / Nestelberger, Thomas; Wildi, Karin; Boeddinghaus, Jasper; Twerenbold, Raphael; Reichlin, Tobias; Giménez, Maria Rubini; Puelacher, Christian; Jaeger, Cedric; Grimm, Karin; Sabti, Zaid; Hillinger, Petra; Kozhuharov, Nikola; du Fay de Lavallaz, Jeanne; Pinck, Florentina; Lopez, Beatriz; Salgado, Emilio; Miró, Òscar; Bingisser, Roland; Lohrmann, Jens; Osswald, Stefan; Mueller, Christian.
In: INT J CARDIOL, Vol. 207, 15.03.2016, p. 238-245.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Characterization of the observe zone of the ESC 2015 high-sensitivity cardiac troponin 0h/1h-algorithm for the early diagnosis of acute myocardial infarction
AU - Nestelberger, Thomas
AU - Wildi, Karin
AU - Boeddinghaus, Jasper
AU - Twerenbold, Raphael
AU - Reichlin, Tobias
AU - Giménez, Maria Rubini
AU - Puelacher, Christian
AU - Jaeger, Cedric
AU - Grimm, Karin
AU - Sabti, Zaid
AU - Hillinger, Petra
AU - Kozhuharov, Nikola
AU - du Fay de Lavallaz, Jeanne
AU - Pinck, Florentina
AU - Lopez, Beatriz
AU - Salgado, Emilio
AU - Miró, Òscar
AU - Bingisser, Roland
AU - Lohrmann, Jens
AU - Osswald, Stefan
AU - Mueller, Christian
N1 - Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
PY - 2016/3/15
Y1 - 2016/3/15
N2 - OBJECTIVE: The novel high-sensitivity cardiac troponin (hs-cTn) 0h/1h-algorithm substantially improves the early triage of patient's assigned "rule-out" or "rule-in" of acute myocardial infarction (AMI), while diagnostic uncertainty remains in that 25-30% of patients assigned to "observe". We aimed to better characterize these patients.METHODS: In a prospective multicenter diagnostic study, we applied the hs-cTnT 0h/1h-algorithm in 2213 unselected patients presenting with symptoms suggestive of AMI to the emergency department. The final diagnosis was adjudicated by two independent cardiologists using all available information. Survival at 720-days was the prognostic endpoint. Findings were validated using a hs-cTnI 0h/1h-algorithm.RESULTS: Twenty-four percent (n=523) of patients were assigned to "observe" by the hs-cTnT 0h/1h-algorithm. These patients differed significantly in multiple characteristics from "rule-out" and "rule-in" patients: they were older, in 75% male, and very often (57%) had pre-existing coronary artery disease (CAD). Diagnostic uncertainty for the presence of an AMI/UA was high. Only 39% of patients were suitable for coronary computed tomography angiography (CCTA). The most common final adjudicated diagnoses were non-cardiac disease (38%), non-coronary cardiac disease (24%), unstable angina (UA, 21%), and AMI (15%). Absolute hs-cTnT-changes within 3h had the highest diagnostic accuracy for AMI (AUC 0.86). Cumulative 720-day survival rate was 86%, which was significantly lower as compared to "rule-out" (p<0.001) and comparable to "rule-in" (p=ns). Findings were similar for the hs-cTnI "observe" zone.CONCLUSION: "Observe" patients are typically elderly men with pre-existing CAD and high long-term mortality. Absolute hs-cTn-changes within 3h, functional stress imaging and coronary angiography are the key diagnostic modalities.
AB - OBJECTIVE: The novel high-sensitivity cardiac troponin (hs-cTn) 0h/1h-algorithm substantially improves the early triage of patient's assigned "rule-out" or "rule-in" of acute myocardial infarction (AMI), while diagnostic uncertainty remains in that 25-30% of patients assigned to "observe". We aimed to better characterize these patients.METHODS: In a prospective multicenter diagnostic study, we applied the hs-cTnT 0h/1h-algorithm in 2213 unselected patients presenting with symptoms suggestive of AMI to the emergency department. The final diagnosis was adjudicated by two independent cardiologists using all available information. Survival at 720-days was the prognostic endpoint. Findings were validated using a hs-cTnI 0h/1h-algorithm.RESULTS: Twenty-four percent (n=523) of patients were assigned to "observe" by the hs-cTnT 0h/1h-algorithm. These patients differed significantly in multiple characteristics from "rule-out" and "rule-in" patients: they were older, in 75% male, and very often (57%) had pre-existing coronary artery disease (CAD). Diagnostic uncertainty for the presence of an AMI/UA was high. Only 39% of patients were suitable for coronary computed tomography angiography (CCTA). The most common final adjudicated diagnoses were non-cardiac disease (38%), non-coronary cardiac disease (24%), unstable angina (UA, 21%), and AMI (15%). Absolute hs-cTnT-changes within 3h had the highest diagnostic accuracy for AMI (AUC 0.86). Cumulative 720-day survival rate was 86%, which was significantly lower as compared to "rule-out" (p<0.001) and comparable to "rule-in" (p=ns). Findings were similar for the hs-cTnI "observe" zone.CONCLUSION: "Observe" patients are typically elderly men with pre-existing CAD and high long-term mortality. Absolute hs-cTn-changes within 3h, functional stress imaging and coronary angiography are the key diagnostic modalities.
KW - Aged
KW - Algorithms
KW - Biomarkers/blood
KW - Early Diagnosis
KW - Female
KW - Humans
KW - Internationality
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/blood
KW - Prospective Studies
KW - Time Factors
KW - Troponin T/blood
U2 - 10.1016/j.ijcard.2016.01.112
DO - 10.1016/j.ijcard.2016.01.112
M3 - SCORING: Journal article
C2 - 26808985
VL - 207
SP - 238
EP - 245
JO - INT J CARDIOL
JF - INT J CARDIOL
SN - 0167-5273
ER -
