Immediate Rule-Out of Acute Myocardial Infarction Using Electrocardiogram and Baseline High-Sensitivity Troponin I
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Immediate Rule-Out of Acute Myocardial Infarction Using Electrocardiogram and Baseline High-Sensitivity Troponin I. / Neumann, Johannes Tobias; Sörensen, Nils Arne; Ojeda, Francisco; Schwemer, Tjark; Lehmacher, Jonas; Gönner, Saskia; Jarsetz, Nikolas; Keller, Till; Schaefer, Sarina; Renné, Thomas; Landmesser, Ulf; Clemmensen, Peter; Makarova, Nataliya; Schnabel, Renate B; Zeller, Tanja; Karakas, Mahir; Pickering, John W; Than, Martin; Parsonage, William; Greenslade, Jaimi; Cullen, Louise; Westermann, Dirk; Blankenberg, Stefan.
In: CLIN CHEM, Vol. 63, No. 1, 01.2017, p. 394-402.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Immediate Rule-Out of Acute Myocardial Infarction Using Electrocardiogram and Baseline High-Sensitivity Troponin I
AU - Neumann, Johannes Tobias
AU - Sörensen, Nils Arne
AU - Ojeda, Francisco
AU - Schwemer, Tjark
AU - Lehmacher, Jonas
AU - Gönner, Saskia
AU - Jarsetz, Nikolas
AU - Keller, Till
AU - Schaefer, Sarina
AU - Renné, Thomas
AU - Landmesser, Ulf
AU - Clemmensen, Peter
AU - Makarova, Nataliya
AU - Schnabel, Renate B
AU - Zeller, Tanja
AU - Karakas, Mahir
AU - Pickering, John W
AU - Than, Martin
AU - Parsonage, William
AU - Greenslade, Jaimi
AU - Cullen, Louise
AU - Westermann, Dirk
AU - Blankenberg, Stefan
N1 - © 2016 American Association for Clinical Chemistry.
PY - 2017/1
Y1 - 2017/1
N2 - AIMS: Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG) to rule out AMI.METHODS: Troponin I measured with a high-sensitivity assay (hs-TnI) was determined at admission in 1040 patients presenting with suspected AMI (BACC study). To rule out AMI we calculated the negative predictive value (NPV) utilizing the optimal hs-TnI cutoff combined with a low risk ECG. The results were validated in 3566 patients with suspected AMI [2-h Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) studies]. Patients were followed for 6 or 12 months.RESULTS: 184 of all patients were diagnosed with AMI. An hs-TnI cutoff of 3 ng/L resulted in a NPV of 99.3% (CI 97.3-100.0), ruling out 35% of all non-AMI patients. Adding the information of a low risk ECG resulted in a 100% (CI 97.5-100.0) NPV (28% ruled out). The 2 validation cohorts replicated the high NPV of this approach. The follow-up mortality in the ruled out population was low (0 deaths in BACC and Stenocardia, 1 death in ADAPT).CONCLUSIONS: A single hs-TnI measurement on admission combined with a low risk ECG appears to rule out AMI safely without need for serial troponin testing.TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02355457).
AB - AIMS: Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG) to rule out AMI.METHODS: Troponin I measured with a high-sensitivity assay (hs-TnI) was determined at admission in 1040 patients presenting with suspected AMI (BACC study). To rule out AMI we calculated the negative predictive value (NPV) utilizing the optimal hs-TnI cutoff combined with a low risk ECG. The results were validated in 3566 patients with suspected AMI [2-h Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) studies]. Patients were followed for 6 or 12 months.RESULTS: 184 of all patients were diagnosed with AMI. An hs-TnI cutoff of 3 ng/L resulted in a NPV of 99.3% (CI 97.3-100.0), ruling out 35% of all non-AMI patients. Adding the information of a low risk ECG resulted in a 100% (CI 97.5-100.0) NPV (28% ruled out). The 2 validation cohorts replicated the high NPV of this approach. The follow-up mortality in the ruled out population was low (0 deaths in BACC and Stenocardia, 1 death in ADAPT).CONCLUSIONS: A single hs-TnI measurement on admission combined with a low risk ECG appears to rule out AMI safely without need for serial troponin testing.TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02355457).
KW - Acute Disease
KW - Aged
KW - Biomarkers
KW - Electrocardiography
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction
KW - Troponin I
KW - Clinical Trial
KW - Journal Article
U2 - 10.1373/clinchem.2016.262659
DO - 10.1373/clinchem.2016.262659
M3 - SCORING: Journal article
C2 - 27903616
VL - 63
SP - 394
EP - 402
JO - CLIN CHEM
JF - CLIN CHEM
SN - 0009-9147
IS - 1
ER -