One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I
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One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I. / Jaeger, Cedric; Wildi, Karin; Twerenbold, Raphael; Reichlin, Tobias; Rubini Gimenez, Maria; Neuhaus, Jean-Daniel; Grimm, Karin; Boeddinghaus, Jasper; Hillinger, Petra; Nestelberger, Thomas; Singeisen, Helene; Gugala, Mathias; Pretre, Gil; Puelacher, Christian; Wagener, Max; Honegger, Ursina; Schumacher, Carmela; Moreno Weidmann, Zoraida; Kreutzinger, Philipp; Krivoshei, Lian; Freese, Michael; Stelzig, Claudia; Dietsche, Sebastian; Ernst, Susanne; Rentsch, Katharina; Osswald, Stefan; Mueller, Christian.
In: AM HEART J, Vol. 171, No. 1, 01.2016, p. 92-102.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I
AU - Jaeger, Cedric
AU - Wildi, Karin
AU - Twerenbold, Raphael
AU - Reichlin, Tobias
AU - Rubini Gimenez, Maria
AU - Neuhaus, Jean-Daniel
AU - Grimm, Karin
AU - Boeddinghaus, Jasper
AU - Hillinger, Petra
AU - Nestelberger, Thomas
AU - Singeisen, Helene
AU - Gugala, Mathias
AU - Pretre, Gil
AU - Puelacher, Christian
AU - Wagener, Max
AU - Honegger, Ursina
AU - Schumacher, Carmela
AU - Moreno Weidmann, Zoraida
AU - Kreutzinger, Philipp
AU - Krivoshei, Lian
AU - Freese, Michael
AU - Stelzig, Claudia
AU - Dietsche, Sebastian
AU - Ernst, Susanne
AU - Rentsch, Katharina
AU - Osswald, Stefan
AU - Mueller, Christian
N1 - Copyright © 2015 Elsevier Inc. All rights reserved.
PY - 2016/1
Y1 - 2016/1
N2 - UNLABELLED: We aimed to prospectively derive and validate a novel 0-/1-hour algorithm using high-sensitivity cardiac troponin I (hs-cTnI) for the early "rule-out" and "rule-in" of acute myocardial infarction (AMI).METHODS: In a prospective multicenter diagnostic study, we enrolled 1,500 patients presenting with suspected AMI to the emergency department. The final diagnosis was centrally adjudicated by 2 independent cardiologists blinded to hs-cTnI concentrations. The hs-cTnI (Siemens Vista) 0-/1-hour algorithm incorporated measurements performed at baseline and absolute changes within 1 hour, was derived in the first 750 patients (derivation cohort), and then validated in the second 750 (validation cohort).RESULTS: Overall, AMI was the final diagnosis in 16% of patients. Applying the hs-cTnI 0-/1-hour algorithm developed in the derivation cohort to the validation cohort, 57% of patients could be classified as "rule-out"; 10%, as "rule-in"; and 33%, as "observe." In the validation cohort, the sensitivity and the negative predictive value for AMI in the "rule-out" zone were 100% (95% CI 96%-100%) and 100% (95% CI 99%-100%), respectively. The specificity and the positive predictive value (PPV) for AMI in the "rule-in" zone were 96% (95% CI 94%-97%) and 70% (95% CI 60%-79%), respectively. Negative predictive value and positive predictive value of the 0-/1-hour algorithm were higher compared to the standard of care combining hs-cTnI with the electrocardiogram (both P < .001).CONCLUSION: The hs-cTnI 0-/1-hour algorithm performs very well for early rule-out as well as rule-in of AMI. The clinical implications are that used in conjunction with all other clinical information, the 0-/1-hour algorithm will be a safe and effective approach to substantially reduce time to diagnosis.
AB - UNLABELLED: We aimed to prospectively derive and validate a novel 0-/1-hour algorithm using high-sensitivity cardiac troponin I (hs-cTnI) for the early "rule-out" and "rule-in" of acute myocardial infarction (AMI).METHODS: In a prospective multicenter diagnostic study, we enrolled 1,500 patients presenting with suspected AMI to the emergency department. The final diagnosis was centrally adjudicated by 2 independent cardiologists blinded to hs-cTnI concentrations. The hs-cTnI (Siemens Vista) 0-/1-hour algorithm incorporated measurements performed at baseline and absolute changes within 1 hour, was derived in the first 750 patients (derivation cohort), and then validated in the second 750 (validation cohort).RESULTS: Overall, AMI was the final diagnosis in 16% of patients. Applying the hs-cTnI 0-/1-hour algorithm developed in the derivation cohort to the validation cohort, 57% of patients could be classified as "rule-out"; 10%, as "rule-in"; and 33%, as "observe." In the validation cohort, the sensitivity and the negative predictive value for AMI in the "rule-out" zone were 100% (95% CI 96%-100%) and 100% (95% CI 99%-100%), respectively. The specificity and the positive predictive value (PPV) for AMI in the "rule-in" zone were 96% (95% CI 94%-97%) and 70% (95% CI 60%-79%), respectively. Negative predictive value and positive predictive value of the 0-/1-hour algorithm were higher compared to the standard of care combining hs-cTnI with the electrocardiogram (both P < .001).CONCLUSION: The hs-cTnI 0-/1-hour algorithm performs very well for early rule-out as well as rule-in of AMI. The clinical implications are that used in conjunction with all other clinical information, the 0-/1-hour algorithm will be a safe and effective approach to substantially reduce time to diagnosis.
KW - Aged
KW - Aged, 80 and over
KW - Algorithms
KW - Biomarkers/blood
KW - Electrocardiography
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/blood
KW - Predictive Value of Tests
KW - Prospective Studies
KW - ROC Curve
KW - Time Factors
KW - Troponin I/blood
U2 - 10.1016/j.ahj.2015.07.022
DO - 10.1016/j.ahj.2015.07.022
M3 - SCORING: Journal article
C2 - 26699605
VL - 171
SP - 92
EP - 102
JO - AM HEART J
JF - AM HEART J
SN - 0002-8703
IS - 1
ER -
