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Early rule-out and rule-in of myocardial infarction using sensitive cardiac Troponin i

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Early rule-out and rule-in of myocardial infarction using sensitive cardiac Troponin i. / Druey, Sophie; Wildi, Karin; Twerenbold, Raphael; Jaeger, Cédric; Reichlin, Tobias; Haaf, Philip; Rubini Gimenez, Maria; Puelacher, Christian; Wagener, Max; Radosavac, Milos; Honegger, Ursina; Schumacher, Carmela; Delfine, Valentina; Kreutzinger, Philip; Herrmann, Thomas; Moreno Weidmann, Zoraida; Krivoshei, Lian; Freese, Michael; Stelzig, Claudia; Isenschmid, Cyril; Bassetti, Stefano; Rentsch, Katharina; Osswald, Stefan; Mueller, Christian.

In: INT J CARDIOL, Vol. 195, 22.07.2015, p. 163-170.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Druey, S, Wildi, K, Twerenbold, R, Jaeger, C, Reichlin, T, Haaf, P, Rubini Gimenez, M, Puelacher, C, Wagener, M, Radosavac, M, Honegger, U, Schumacher, C, Delfine, V, Kreutzinger, P, Herrmann, T, Moreno Weidmann, Z, Krivoshei, L, Freese, M, Stelzig, C, Isenschmid, C, Bassetti, S, Rentsch, K, Osswald, S & Mueller, C 2015, 'Early rule-out and rule-in of myocardial infarction using sensitive cardiac Troponin i', INT J CARDIOL, vol. 195, pp. 163-170. https://doi.org/10.1016/j.ijcard.2015.05.079

APA

Druey, S., Wildi, K., Twerenbold, R., Jaeger, C., Reichlin, T., Haaf, P., Rubini Gimenez, M., Puelacher, C., Wagener, M., Radosavac, M., Honegger, U., Schumacher, C., Delfine, V., Kreutzinger, P., Herrmann, T., Moreno Weidmann, Z., Krivoshei, L., Freese, M., Stelzig, C., ... Mueller, C. (2015). Early rule-out and rule-in of myocardial infarction using sensitive cardiac Troponin i. INT J CARDIOL, 195, 163-170. https://doi.org/10.1016/j.ijcard.2015.05.079

Vancouver

Druey S, Wildi K, Twerenbold R, Jaeger C, Reichlin T, Haaf P et al. Early rule-out and rule-in of myocardial infarction using sensitive cardiac Troponin i. INT J CARDIOL. 2015 Jul 22;195:163-170. https://doi.org/10.1016/j.ijcard.2015.05.079

Bibtex

@article{a7fdf05aed244885ababc7e1f9daf173,
title = "Early rule-out and rule-in of myocardial infarction using sensitive cardiac Troponin i",
abstract = "Background It is currently unknown, whether and to what extent sensitive cardiac troponin (s-cTn) allows shortening of the time required for safe rule-out and rule-in of acute myocardial infarction (AMI). Methods We aimed to develop and validate early rule-out and rule-in algorithms for AMI using a thoroughly-examined and commonly used s-cTnI assay in a prospective multicenter study including 2173 patients presenting to the emergency department with suspected AMI. S-cTnI was measured in a blinded fashion at 0 h, 1 h, and 2 h. The final diagnosis was centrally adjudicated by two independent cardiologists. In the derivation cohort (n = 1496), we developed 1 h- and 2 h-algorithms assigning patients to {"}rule-out{"}, {"}rule-in{"}, or {"}observe{"}. The algorithms were then prospectively validated in the validation cohort (n = 677). Results AMI was the adjudicated diagnosis in 17% of patients. After applying the s-cTnI 1 h-algorithm developed in the derivation cohort to the validation cohort, 65% of patients were classified as {"}rule-out{"}, 12% as {"}rule-in{"}, and 23% to {"}observe{"}. The negative predictive value for AMI in the {"}rule-out{"} group was 98.6% (95% CI, 96.9-99.5), the positive predictive value for AMI in the {"}rule-in{"} group 76.3% (95% CI, 65.4-85.1). Overall, 30-day mortality was 0.2% in the {"}rule-out{"} group, 1.0% in the {"}observe{"} group, and 3.0% in the {"}rule-in{"} group. Similar results were obtained for the 2 h-algorithm. Conclusion When used in conjunction with other clinical information including the ECG, a simple algorithm incorporating s-cTnI values at presentation and after 1 h (or 2 h) will allow safe rule-out and accurate rule-in of AMI in the majority of patients.",
keywords = "AMI acute myocardial infarction, cTn cardiac Troponin, ECG electrocardiogram, ED emergency department, hs-cTn high-sensitivity cardiac Troponin, NPV negative predictive value, PPV positive predictive value, s-cTn sensitive cardiac Troponin, s-cTnI sensitive cardiac Troponin I",
author = "Sophie Druey and Karin Wildi and Raphael Twerenbold and C{\'e}dric Jaeger and Tobias Reichlin and Philip Haaf and {Rubini Gimenez}, Maria and Christian Puelacher and Max Wagener and Milos Radosavac and Ursina Honegger and Carmela Schumacher and Valentina Delfine and Philip Kreutzinger and Thomas Herrmann and {Moreno Weidmann}, Zoraida and Lian Krivoshei and Michael Freese and Claudia Stelzig and Cyril Isenschmid and Stefano Bassetti and Katharina Rentsch and Stefan Osswald and Christian Mueller",
note = "Publisher Copyright: {\textcopyright} 2015 Elsevier Ireland Ltd. All rights reserved.",
year = "2015",
month = jul,
day = "22",
doi = "10.1016/j.ijcard.2015.05.079",
language = "English",
volume = "195",
pages = "163--170",
journal = "INT J CARDIOL",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

RIS

TY - JOUR

T1 - Early rule-out and rule-in of myocardial infarction using sensitive cardiac Troponin i

AU - Druey, Sophie

AU - Wildi, Karin

AU - Twerenbold, Raphael

AU - Jaeger, Cédric

AU - Reichlin, Tobias

AU - Haaf, Philip

AU - Rubini Gimenez, Maria

AU - Puelacher, Christian

AU - Wagener, Max

AU - Radosavac, Milos

AU - Honegger, Ursina

AU - Schumacher, Carmela

AU - Delfine, Valentina

AU - Kreutzinger, Philip

AU - Herrmann, Thomas

AU - Moreno Weidmann, Zoraida

AU - Krivoshei, Lian

AU - Freese, Michael

AU - Stelzig, Claudia

AU - Isenschmid, Cyril

AU - Bassetti, Stefano

AU - Rentsch, Katharina

AU - Osswald, Stefan

AU - Mueller, Christian

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

PY - 2015/7/22

Y1 - 2015/7/22

N2 - Background It is currently unknown, whether and to what extent sensitive cardiac troponin (s-cTn) allows shortening of the time required for safe rule-out and rule-in of acute myocardial infarction (AMI). Methods We aimed to develop and validate early rule-out and rule-in algorithms for AMI using a thoroughly-examined and commonly used s-cTnI assay in a prospective multicenter study including 2173 patients presenting to the emergency department with suspected AMI. S-cTnI was measured in a blinded fashion at 0 h, 1 h, and 2 h. The final diagnosis was centrally adjudicated by two independent cardiologists. In the derivation cohort (n = 1496), we developed 1 h- and 2 h-algorithms assigning patients to "rule-out", "rule-in", or "observe". The algorithms were then prospectively validated in the validation cohort (n = 677). Results AMI was the adjudicated diagnosis in 17% of patients. After applying the s-cTnI 1 h-algorithm developed in the derivation cohort to the validation cohort, 65% of patients were classified as "rule-out", 12% as "rule-in", and 23% to "observe". The negative predictive value for AMI in the "rule-out" group was 98.6% (95% CI, 96.9-99.5), the positive predictive value for AMI in the "rule-in" group 76.3% (95% CI, 65.4-85.1). Overall, 30-day mortality was 0.2% in the "rule-out" group, 1.0% in the "observe" group, and 3.0% in the "rule-in" group. Similar results were obtained for the 2 h-algorithm. Conclusion When used in conjunction with other clinical information including the ECG, a simple algorithm incorporating s-cTnI values at presentation and after 1 h (or 2 h) will allow safe rule-out and accurate rule-in of AMI in the majority of patients.

AB - Background It is currently unknown, whether and to what extent sensitive cardiac troponin (s-cTn) allows shortening of the time required for safe rule-out and rule-in of acute myocardial infarction (AMI). Methods We aimed to develop and validate early rule-out and rule-in algorithms for AMI using a thoroughly-examined and commonly used s-cTnI assay in a prospective multicenter study including 2173 patients presenting to the emergency department with suspected AMI. S-cTnI was measured in a blinded fashion at 0 h, 1 h, and 2 h. The final diagnosis was centrally adjudicated by two independent cardiologists. In the derivation cohort (n = 1496), we developed 1 h- and 2 h-algorithms assigning patients to "rule-out", "rule-in", or "observe". The algorithms were then prospectively validated in the validation cohort (n = 677). Results AMI was the adjudicated diagnosis in 17% of patients. After applying the s-cTnI 1 h-algorithm developed in the derivation cohort to the validation cohort, 65% of patients were classified as "rule-out", 12% as "rule-in", and 23% to "observe". The negative predictive value for AMI in the "rule-out" group was 98.6% (95% CI, 96.9-99.5), the positive predictive value for AMI in the "rule-in" group 76.3% (95% CI, 65.4-85.1). Overall, 30-day mortality was 0.2% in the "rule-out" group, 1.0% in the "observe" group, and 3.0% in the "rule-in" group. Similar results were obtained for the 2 h-algorithm. Conclusion When used in conjunction with other clinical information including the ECG, a simple algorithm incorporating s-cTnI values at presentation and after 1 h (or 2 h) will allow safe rule-out and accurate rule-in of AMI in the majority of patients.

KW - AMI acute myocardial infarction

KW - cTn cardiac Troponin

KW - ECG electrocardiogram

KW - ED emergency department

KW - hs-cTn high-sensitivity cardiac Troponin

KW - NPV negative predictive value

KW - PPV positive predictive value

KW - s-cTn sensitive cardiac Troponin

KW - s-cTnI sensitive cardiac Troponin I

UR - http://www.scopus.com/inward/record.url?scp=84937547499&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2015.05.079

DO - 10.1016/j.ijcard.2015.05.079

M3 - SCORING: Journal article

C2 - 26043151

AN - SCOPUS:84937547499

VL - 195

SP - 163

EP - 170

JO - INT J CARDIOL

JF - INT J CARDIOL

SN - 0167-5273

ER -