External validation of the clinical chemistry score
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External validation of the clinical chemistry score. / Wildi, Karin; Boeddinghaus, Jasper; Nestelberger, Thomas; Haaf, Philip; Koechlin, Luca; Ayala Lopez, Pedro; Walter, Joan; Badertscher, Patrick; Ratmann, Paul David; Miró, Òscar; Martin-Sanchez, F Javier; Muzyk, Piotr; Kaeslin, Marina; RubiniGiménez, Maria; M Gualandro, Danielle; Buergler, Franz; Keller, Dagmar I; Christ, Michael; Twerenbold, Raphael; Mueller, Christian.
In: CLIN BIOCHEM, Vol. 91, 05.2021, p. 16-25.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - External validation of the clinical chemistry score
AU - Wildi, Karin
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - Haaf, Philip
AU - Koechlin, Luca
AU - Ayala Lopez, Pedro
AU - Walter, Joan
AU - Badertscher, Patrick
AU - Ratmann, Paul David
AU - Miró, Òscar
AU - Martin-Sanchez, F Javier
AU - Muzyk, Piotr
AU - Kaeslin, Marina
AU - RubiniGiménez, Maria
AU - M Gualandro, Danielle
AU - Buergler, Franz
AU - Keller, Dagmar I
AU - Christ, Michael
AU - Twerenbold, Raphael
AU - Mueller, Christian
N1 - Copyright © 2021 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
PY - 2021/5
Y1 - 2021/5
N2 - BACKGROUND: Combining high-sensitivity cardiac troponin (hs-cTn) with estimated glomerular filtration rate and glucose within the Clinical Chemistry Score (CCS) could help in the assessment of patients with suspected acute myocardial infarction (AMI).METHODS: In patients presenting with suspected AMI to the emergency department, we aimed to externally validate the performance of the CCS in a prospective international multicenter study and to directly compare the diagnostic and prognostic performance of the CCS with hs-cTnT and hs-cTnI baseline levels alone using a single cut-off approach. The diagnostic endpoint was diagnostic accuracy for AMI as centrally adjudicated by two independent cardiologists including cardiac imaging and serial hs-cTnT/I measurements. The prognostic endpoint was 30-day AMI or death.RESULTS: AMI was the final diagnosis in 620/3827 patients (16.2%) adjudicated with hs-cTnT and 599 patients (15.7%) adjudicated with hs-cTnI. The CCS resulted in high diagnostic accuracy for AMI and prognostic accuracy for 30-days AMI/death as quantified by the area under the receiver-operating characteristic curve (AUC), using hs-cTnT 0.90 (95%CI 0.89-0.91) and 0.89 (95%CI 0.88-0.90), using hs-cTnI 0.91 (95%Cl 0.90-0.92) and 0.90 (95%CI 0.89-0.91) respectively. E.g. a CCS of 0 points resulted in a sensitivity of 99.8% (95%CI 99.1-100%) for rule-out of index AMI and 99.5% (95%CI 98.5-100%) for AMI/death at 30 days for hs-cTnT and 99.8% (95%CI 98.9-100%) and 99.6% (95%CI 98.6-100%) using hs-cTnI. Overall, the single hs-cTnT/I measurement approach provided comparable diagnostic (sensitivity 99.5-99.7%) and prognostic (sensitivity 98.9-99.5%) performance versus the CCS.INTERPRETATION: The CCS provided high diagnostic and prognostic performance also in this independent large validation cohort. A single hs-cTnT/I measurement approach for rule-out MI yielded similar estimates.
AB - BACKGROUND: Combining high-sensitivity cardiac troponin (hs-cTn) with estimated glomerular filtration rate and glucose within the Clinical Chemistry Score (CCS) could help in the assessment of patients with suspected acute myocardial infarction (AMI).METHODS: In patients presenting with suspected AMI to the emergency department, we aimed to externally validate the performance of the CCS in a prospective international multicenter study and to directly compare the diagnostic and prognostic performance of the CCS with hs-cTnT and hs-cTnI baseline levels alone using a single cut-off approach. The diagnostic endpoint was diagnostic accuracy for AMI as centrally adjudicated by two independent cardiologists including cardiac imaging and serial hs-cTnT/I measurements. The prognostic endpoint was 30-day AMI or death.RESULTS: AMI was the final diagnosis in 620/3827 patients (16.2%) adjudicated with hs-cTnT and 599 patients (15.7%) adjudicated with hs-cTnI. The CCS resulted in high diagnostic accuracy for AMI and prognostic accuracy for 30-days AMI/death as quantified by the area under the receiver-operating characteristic curve (AUC), using hs-cTnT 0.90 (95%CI 0.89-0.91) and 0.89 (95%CI 0.88-0.90), using hs-cTnI 0.91 (95%Cl 0.90-0.92) and 0.90 (95%CI 0.89-0.91) respectively. E.g. a CCS of 0 points resulted in a sensitivity of 99.8% (95%CI 99.1-100%) for rule-out of index AMI and 99.5% (95%CI 98.5-100%) for AMI/death at 30 days for hs-cTnT and 99.8% (95%CI 98.9-100%) and 99.6% (95%CI 98.6-100%) using hs-cTnI. Overall, the single hs-cTnT/I measurement approach provided comparable diagnostic (sensitivity 99.5-99.7%) and prognostic (sensitivity 98.9-99.5%) performance versus the CCS.INTERPRETATION: The CCS provided high diagnostic and prognostic performance also in this independent large validation cohort. A single hs-cTnT/I measurement approach for rule-out MI yielded similar estimates.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Disease-Free Survival
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/blood
KW - Prospective Studies
KW - Survival Rate
KW - Troponin C/blood
U2 - 10.1016/j.clinbiochem.2021.02.006
DO - 10.1016/j.clinbiochem.2021.02.006
M3 - SCORING: Journal article
C2 - 33636187
VL - 91
SP - 16
EP - 25
JO - CLIN BIOCHEM
JF - CLIN BIOCHEM
SN - 0009-9120
ER -
