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One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T

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One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. / Reichlin, Tobias; Schindler, Christian; Drexler, Beatrice; Twerenbold, Raphael; Reiter, Miriam; Zellweger, Christa; Moehring, Berit; Ziller, Ronny; Hoeller, Rebeca; Rubini Gimenez, Maria; Haaf, Philip; Potocki, Mihael; Wildi, Karin; Balmelli, Cathrin; Freese, Michael; Stelzig, Claudia; Freidank, Heike; Osswald, Stefan; Mueller, Christian.

In: JAMA INTERN MED, Vol. 172, No. 16, 10.09.2012, p. 1211-1218.

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

Harvard

Reichlin, T, Schindler, C, Drexler, B, Twerenbold, R, Reiter, M, Zellweger, C, Moehring, B, Ziller, R, Hoeller, R, Rubini Gimenez, M, Haaf, P, Potocki, M, Wildi, K, Balmelli, C, Freese, M, Stelzig, C, Freidank, H, Osswald, S & Mueller, C 2012, 'One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T', JAMA INTERN MED, vol. 172, no. 16, pp. 1211-1218. https://doi.org/10.1001/archinternmed.2012.3698

APA

Reichlin, T., Schindler, C., Drexler, B., Twerenbold, R., Reiter, M., Zellweger, C., Moehring, B., Ziller, R., Hoeller, R., Rubini Gimenez, M., Haaf, P., Potocki, M., Wildi, K., Balmelli, C., Freese, M., Stelzig, C., Freidank, H., Osswald, S., & Mueller, C. (2012). One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. JAMA INTERN MED, 172(16), 1211-1218. https://doi.org/10.1001/archinternmed.2012.3698

Vancouver

Reichlin T, Schindler C, Drexler B, Twerenbold R, Reiter M, Zellweger C et al. One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. JAMA INTERN MED. 2012 Sep 10;172(16):1211-1218. https://doi.org/10.1001/archinternmed.2012.3698

Bibtex

@article{a607c66a92244711994bd2c947531da7,
title = "One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T",
abstract = "Background: High-sensitivity cardiac troponin (hs-cTn) assays seem to improve the early diagnosis of acute myocardial infarction (AMI), but it is unknown how to best use them in clinical practice. Our objective was to develop and validate an algorithm for rapid rule-out and rule-in of AMI. Methods: A prospective multicenter study enrolling 872 unselected patients with acute chest pain presenting to the emergency department. High-sensitivity cardiac troponin T (hs-cTnT) was measured in a blinded fashion at presentation and after 1 hour. The final diagnosis was adjudicated by 2 independent cardiologists. An hs-cTnT algorithm incorporating baseline values as well as absolute changes within the first hour was derived from 436 randomly selected patients and validated in the remaining 436 patients. The primary prognostic end point was death during 30 days of follow-up. Results: Acute myocardial infarction was the final diagnosis in 17% of patients. After applying the hs-cTnT algorithm developed in the derivation cohort to the validation cohort, 259 patients (60%) could be classified as {"}rule-out,{"} 76 patients (17%) as {"}rule-in,{"} and 101 patients (23%) as in the {"}observational zone{"} within 1 hour. Overall, this resulted in a sensitivity and negative predictive value of 100% for rule-out, a specificity and positive predictive value of 97% and 84%, respectively, for rule-in, and a prevalence of AMI of 8% in the observational zone group. Cumulative 30-day survival was 99.8%, 98.6%, and 95.3% (P < .001) in patients classified as rule-out, observational zone, and rule-in, respectively. Conclusions: Using a simple algorithm incorporating hs-cTnT baseline values and absolute changes within the first hour allowed a safe rule-out as well as an accurate rule-in of AMI within 1 hour in 77% of unselected patients with acute chest pain. This novel strategy may obviate the need for prolonged monitoring and serial blood sampling in 3 of 4 patients.",
author = "Tobias Reichlin and Christian Schindler and Beatrice Drexler and Raphael Twerenbold and Miriam Reiter and Christa Zellweger and Berit Moehring and Ronny Ziller and Rebeca Hoeller and {Rubini Gimenez}, Maria and Philip Haaf and Mihael Potocki and Karin Wildi and Cathrin Balmelli and Michael Freese and Claudia Stelzig and Heike Freidank and Stefan Osswald and Christian Mueller",
year = "2012",
month = sep,
day = "10",
doi = "10.1001/archinternmed.2012.3698",
language = "English",
volume = "172",
pages = "1211--1218",
journal = "JAMA INTERN MED",
issn = "2168-6106",
publisher = "American Medical Association",
number = "16",

}

RIS

TY - JOUR

T1 - One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T

AU - Reichlin, Tobias

AU - Schindler, Christian

AU - Drexler, Beatrice

AU - Twerenbold, Raphael

AU - Reiter, Miriam

AU - Zellweger, Christa

AU - Moehring, Berit

AU - Ziller, Ronny

AU - Hoeller, Rebeca

AU - Rubini Gimenez, Maria

AU - Haaf, Philip

AU - Potocki, Mihael

AU - Wildi, Karin

AU - Balmelli, Cathrin

AU - Freese, Michael

AU - Stelzig, Claudia

AU - Freidank, Heike

AU - Osswald, Stefan

AU - Mueller, Christian

PY - 2012/9/10

Y1 - 2012/9/10

N2 - Background: High-sensitivity cardiac troponin (hs-cTn) assays seem to improve the early diagnosis of acute myocardial infarction (AMI), but it is unknown how to best use them in clinical practice. Our objective was to develop and validate an algorithm for rapid rule-out and rule-in of AMI. Methods: A prospective multicenter study enrolling 872 unselected patients with acute chest pain presenting to the emergency department. High-sensitivity cardiac troponin T (hs-cTnT) was measured in a blinded fashion at presentation and after 1 hour. The final diagnosis was adjudicated by 2 independent cardiologists. An hs-cTnT algorithm incorporating baseline values as well as absolute changes within the first hour was derived from 436 randomly selected patients and validated in the remaining 436 patients. The primary prognostic end point was death during 30 days of follow-up. Results: Acute myocardial infarction was the final diagnosis in 17% of patients. After applying the hs-cTnT algorithm developed in the derivation cohort to the validation cohort, 259 patients (60%) could be classified as "rule-out," 76 patients (17%) as "rule-in," and 101 patients (23%) as in the "observational zone" within 1 hour. Overall, this resulted in a sensitivity and negative predictive value of 100% for rule-out, a specificity and positive predictive value of 97% and 84%, respectively, for rule-in, and a prevalence of AMI of 8% in the observational zone group. Cumulative 30-day survival was 99.8%, 98.6%, and 95.3% (P < .001) in patients classified as rule-out, observational zone, and rule-in, respectively. Conclusions: Using a simple algorithm incorporating hs-cTnT baseline values and absolute changes within the first hour allowed a safe rule-out as well as an accurate rule-in of AMI within 1 hour in 77% of unselected patients with acute chest pain. This novel strategy may obviate the need for prolonged monitoring and serial blood sampling in 3 of 4 patients.

AB - Background: High-sensitivity cardiac troponin (hs-cTn) assays seem to improve the early diagnosis of acute myocardial infarction (AMI), but it is unknown how to best use them in clinical practice. Our objective was to develop and validate an algorithm for rapid rule-out and rule-in of AMI. Methods: A prospective multicenter study enrolling 872 unselected patients with acute chest pain presenting to the emergency department. High-sensitivity cardiac troponin T (hs-cTnT) was measured in a blinded fashion at presentation and after 1 hour. The final diagnosis was adjudicated by 2 independent cardiologists. An hs-cTnT algorithm incorporating baseline values as well as absolute changes within the first hour was derived from 436 randomly selected patients and validated in the remaining 436 patients. The primary prognostic end point was death during 30 days of follow-up. Results: Acute myocardial infarction was the final diagnosis in 17% of patients. After applying the hs-cTnT algorithm developed in the derivation cohort to the validation cohort, 259 patients (60%) could be classified as "rule-out," 76 patients (17%) as "rule-in," and 101 patients (23%) as in the "observational zone" within 1 hour. Overall, this resulted in a sensitivity and negative predictive value of 100% for rule-out, a specificity and positive predictive value of 97% and 84%, respectively, for rule-in, and a prevalence of AMI of 8% in the observational zone group. Cumulative 30-day survival was 99.8%, 98.6%, and 95.3% (P < .001) in patients classified as rule-out, observational zone, and rule-in, respectively. Conclusions: Using a simple algorithm incorporating hs-cTnT baseline values and absolute changes within the first hour allowed a safe rule-out as well as an accurate rule-in of AMI within 1 hour in 77% of unselected patients with acute chest pain. This novel strategy may obviate the need for prolonged monitoring and serial blood sampling in 3 of 4 patients.

UR - http://www.scopus.com/inward/record.url?scp=84866103717&partnerID=8YFLogxK

U2 - 10.1001/archinternmed.2012.3698

DO - 10.1001/archinternmed.2012.3698

M3 - SCORING: Journal article

C2 - 22892889

AN - SCOPUS:84866103717

VL - 172

SP - 1211

EP - 1218

JO - JAMA INTERN MED

JF - JAMA INTERN MED

SN - 2168-6106

IS - 16

ER -