Comparison of fourteen rule-out strategies for acute myocardial infarction
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Comparison of fourteen rule-out strategies for acute myocardial infarction. / Wildi, Karin; Boeddinghaus, Jasper; Nestelberger, Thomas; Twerenbold, Raphael; Badertscher, Patrick; Wussler, Desiree; Giménez, Maria Rubini; Puelacher, Christian; du Fay de Lavallaz, Jeanne; Dietsche, Sebastian; Walter, Joan; Kozhuharov, Nikola; Morawiec, Beata; Miró, Òscar; Javier Martin-Sanchez, F; Subramaniam, Sinthuri; Geigy, Nicolas; Keller, Dagmar I; Reichlin, Tobias; Mueller, Christian; APACE Investigators.
In: INT J CARDIOL, Vol. 283, 15.05.2019, p. 41-47.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Comparison of fourteen rule-out strategies for acute myocardial infarction
AU - Wildi, Karin
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - Twerenbold, Raphael
AU - Badertscher, Patrick
AU - Wussler, Desiree
AU - Giménez, Maria Rubini
AU - Puelacher, Christian
AU - du Fay de Lavallaz, Jeanne
AU - Dietsche, Sebastian
AU - Walter, Joan
AU - Kozhuharov, Nikola
AU - Morawiec, Beata
AU - Miró, Òscar
AU - Javier Martin-Sanchez, F
AU - Subramaniam, Sinthuri
AU - Geigy, Nicolas
AU - Keller, Dagmar I
AU - Reichlin, Tobias
AU - Mueller, Christian
AU - APACE Investigators
N1 - Copyright © 2018 Elsevier B.V. All rights reserved.
PY - 2019/5/15
Y1 - 2019/5/15
N2 - BACKGROUND: The clinical availability of high-sensitivity cardiac troponin (hs-cTn) has enabled the development of several innovative strategies for the rapid rule-out of acute myocardial infarction (AMI). Due to the lack of direct comparisons, selection of the best strategy for clinical practice is challenging.METHODS: In a prospective international multicenter diagnostic study enrolling 3696 patients presenting with suspected AMI to the emergency department, we compared the safety and efficacy of 14 different hs-cTn-based strategies: hs-cTn concentrations below the limit of detection (LoD), dual-marker combining hs-cTn with copeptin, ESC 0 h/1 h-algorithm, 0 h/2 h-algorithm, 2 h-ADP-algorithm, NICE-algorithm, and ESC 0 h/3 h-algorithm, each using either hs-cTnT or hs-cTnI. The final diagnosis of AMI was adjudicated by two independent cardiologists using all available clinical information including cardiac imaging and serial hs-cTn concentrations.RESULTS: AMI was the final diagnosis in 16% of patients. Using hs-cTnT, safety quantified by the negative predictive value (NPV) and sensitivity was very high (99.8-100% and 99.5-100%) and comparable for all strategies, except the dual-marker approach (NPV 98.7%, sensitivity 96.7%). Similarly, using hs-cTnI, safety quantified by the NPV and sensitivity was very high (99.7-100% and 98.9-100%) and comparable for all strategies, except the dual-marker approach (NPV 96.9%, sensitivity 90.4%) and the NICE-algorithm (NPV 99.1%, sensitivity 94.7%). Efficacy, quantified by the percentage of patients eligible for rule-out, differed markedly, and was lowest for LoD-algorithm (15.7-26.8%).CONCLUSION: All rapid rule-out algorithms, except the dual-marker strategy and the NICE-algorithm using hs-cTnI, favorably combine safety and efficacy, and can be considered for routine clinical practice.CLINICAL TRIAL REGISTRATION: NCT00470587, http://clinicaltrials.gov/show/NCT00470587.
AB - BACKGROUND: The clinical availability of high-sensitivity cardiac troponin (hs-cTn) has enabled the development of several innovative strategies for the rapid rule-out of acute myocardial infarction (AMI). Due to the lack of direct comparisons, selection of the best strategy for clinical practice is challenging.METHODS: In a prospective international multicenter diagnostic study enrolling 3696 patients presenting with suspected AMI to the emergency department, we compared the safety and efficacy of 14 different hs-cTn-based strategies: hs-cTn concentrations below the limit of detection (LoD), dual-marker combining hs-cTn with copeptin, ESC 0 h/1 h-algorithm, 0 h/2 h-algorithm, 2 h-ADP-algorithm, NICE-algorithm, and ESC 0 h/3 h-algorithm, each using either hs-cTnT or hs-cTnI. The final diagnosis of AMI was adjudicated by two independent cardiologists using all available clinical information including cardiac imaging and serial hs-cTn concentrations.RESULTS: AMI was the final diagnosis in 16% of patients. Using hs-cTnT, safety quantified by the negative predictive value (NPV) and sensitivity was very high (99.8-100% and 99.5-100%) and comparable for all strategies, except the dual-marker approach (NPV 98.7%, sensitivity 96.7%). Similarly, using hs-cTnI, safety quantified by the NPV and sensitivity was very high (99.7-100% and 98.9-100%) and comparable for all strategies, except the dual-marker approach (NPV 96.9%, sensitivity 90.4%) and the NICE-algorithm (NPV 99.1%, sensitivity 94.7%). Efficacy, quantified by the percentage of patients eligible for rule-out, differed markedly, and was lowest for LoD-algorithm (15.7-26.8%).CONCLUSION: All rapid rule-out algorithms, except the dual-marker strategy and the NICE-algorithm using hs-cTnI, favorably combine safety and efficacy, and can be considered for routine clinical practice.CLINICAL TRIAL REGISTRATION: NCT00470587, http://clinicaltrials.gov/show/NCT00470587.
KW - Aged
KW - Aged, 80 and over
KW - Algorithms
KW - Biomarkers/blood
KW - Coronary Angiography
KW - Coronary Care Units
KW - Electrocardiography
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/diagnosis
KW - Practice Guidelines as Topic
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Time Factors
KW - Triage/standards
KW - Troponin I/blood
KW - Troponin T/blood
U2 - 10.1016/j.ijcard.2018.11.140
DO - 10.1016/j.ijcard.2018.11.140
M3 - SCORING: Journal article
C2 - 30545622
VL - 283
SP - 41
EP - 47
JO - INT J CARDIOL
JF - INT J CARDIOL
SN - 0167-5273
ER -
