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Performance of the ESC 0/1-h and 0/3-h Algorithm for the Rapid Identification of Myocardial Infarction Without ST-Elevation in Patients With Diabetes

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Performance of the ESC 0/1-h and 0/3-h Algorithm for the Rapid Identification of Myocardial Infarction Without ST-Elevation in Patients With Diabetes. / Haller, Paul M; Boeddinghaus, Jasper; Neumann, Johannes T; Sörensen, Nils A; Hartikainen, Tau S; Goßling, Alina; Nestelberger, Thomas; Twerenbold, Raphael; Lehmacher, Jonas; Keller, Till; Zeller, Tanja; Blankenberg, Stefan; Mueller, Christian; Westermann, Dirk.

In: DIABETES CARE, Vol. 43, No. 2, 02.2020, p. 460-467.

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

Harvard

Haller, PM, Boeddinghaus, J, Neumann, JT, Sörensen, NA, Hartikainen, TS, Goßling, A, Nestelberger, T, Twerenbold, R, Lehmacher, J, Keller, T, Zeller, T, Blankenberg, S, Mueller, C & Westermann, D 2020, 'Performance of the ESC 0/1-h and 0/3-h Algorithm for the Rapid Identification of Myocardial Infarction Without ST-Elevation in Patients With Diabetes', DIABETES CARE, vol. 43, no. 2, pp. 460-467. https://doi.org/10.2337/dc19-1327

APA

Haller, P. M., Boeddinghaus, J., Neumann, J. T., Sörensen, N. A., Hartikainen, T. S., Goßling, A., Nestelberger, T., Twerenbold, R., Lehmacher, J., Keller, T., Zeller, T., Blankenberg, S., Mueller, C., & Westermann, D. (2020). Performance of the ESC 0/1-h and 0/3-h Algorithm for the Rapid Identification of Myocardial Infarction Without ST-Elevation in Patients With Diabetes. DIABETES CARE, 43(2), 460-467. https://doi.org/10.2337/dc19-1327

Vancouver

Haller PM, Boeddinghaus J, Neumann JT, Sörensen NA, Hartikainen TS, Goßling A et al. Performance of the ESC 0/1-h and 0/3-h Algorithm for the Rapid Identification of Myocardial Infarction Without ST-Elevation in Patients With Diabetes. DIABETES CARE. 2020 Feb;43(2):460-467. https://doi.org/10.2337/dc19-1327

Bibtex

@article{f8991375f1c9412d8e5d7262ebc305c8,
title = "Performance of the ESC 0/1-h and 0/3-h Algorithm for the Rapid Identification of Myocardial Infarction Without ST-Elevation in Patients With Diabetes",
abstract = "OBJECTIVE: Patients with diabetes mellitus (DM) have elevated levels of high-sensitivity cardiac troponin (hs-cTn). We investigated the diagnostic performance of the European Society of Cardiology (ESC) algorithms to rule out or rule in acute myocardial infarction (AMI) without ST-elevation in patients with DM.RESEARCH DESIGN AND METHODS: We prospectively enrolled 3,681 patients with suspected AMI and stratified those by the presence of DM. The ESC 0/1-h and 0/3-h algorithms were used to calculate negative and positive predictive values (NPV, PPV). In addition, alternative cutoffs were calculated and externally validated in 2,895 patients.RESULTS: In total, 563 patients (15.3%) had DM, and 137 (24.3%) of these had AMI. When the ESC 0/1-h algorithm was used, the NPV was comparable in patients with and without DM (absolute difference [AD] -1.50 [95% CI -5.95, 2.96]). In contrast, the ESC 0/3-h algorithm resulted in a significantly lower NPV in patients with DM (AD -2.27 [95% CI -4.47, -0.07]). The diagnostic performance for rule-in of AMI (PPV) was comparable in both groups: 0/1-h (AD 6.59 [95% CI -19.53, 6.35]) and 0/3-h (AD 1.03 [95% CI -7.63, 9.7]). Alternative cutoffs increased the PPV in both algorithms significantly, while improvements in NPV were only subtle.CONCLUSIONS: Application of the ESC 0/1-h algorithm revealed comparable safety to rule out AMI comparing patients with and without DM, while this was not observed with the ESC 0/3-h algorithm. Although alternative cutoffs might be helpful, patients with DM remain a high-risk population in whom identification of AMI is challenging and who require careful clinical evaluation.",
keywords = "Aged, Algorithms, Arrhythmias, Cardiac/complications, Biomarkers/analysis, Cardiology/organization & administration, Cohort Studies, Diabetes Mellitus/blood, Diabetic Angiopathies/diagnosis, Female, Humans, Male, Middle Aged, Myocardial Infarction/blood, Predictive Value of Tests, Prospective Studies, Risk Factors, Societies, Medical/standards, Time Factors, Troponin I/analysis",
author = "Haller, {Paul M} and Jasper Boeddinghaus and Neumann, {Johannes T} and S{\"o}rensen, {Nils A} and Hartikainen, {Tau S} and Alina Go{\ss}ling and Thomas Nestelberger and Raphael Twerenbold and Jonas Lehmacher and Till Keller and Tanja Zeller and Stefan Blankenberg and Christian Mueller and Dirk Westermann",
note = "{\textcopyright} 2019 by the American Diabetes Association.",
year = "2020",
month = feb,
doi = "10.2337/dc19-1327",
language = "English",
volume = "43",
pages = "460--467",
journal = "DIABETES CARE",
issn = "0149-5992",
publisher = "American Diabetes Association Inc.",
number = "2",

}

RIS

TY - JOUR

T1 - Performance of the ESC 0/1-h and 0/3-h Algorithm for the Rapid Identification of Myocardial Infarction Without ST-Elevation in Patients With Diabetes

AU - Haller, Paul M

AU - Boeddinghaus, Jasper

AU - Neumann, Johannes T

AU - Sörensen, Nils A

AU - Hartikainen, Tau S

AU - Goßling, Alina

AU - Nestelberger, Thomas

AU - Twerenbold, Raphael

AU - Lehmacher, Jonas

AU - Keller, Till

AU - Zeller, Tanja

AU - Blankenberg, Stefan

AU - Mueller, Christian

AU - Westermann, Dirk

N1 - © 2019 by the American Diabetes Association.

PY - 2020/2

Y1 - 2020/2

N2 - OBJECTIVE: Patients with diabetes mellitus (DM) have elevated levels of high-sensitivity cardiac troponin (hs-cTn). We investigated the diagnostic performance of the European Society of Cardiology (ESC) algorithms to rule out or rule in acute myocardial infarction (AMI) without ST-elevation in patients with DM.RESEARCH DESIGN AND METHODS: We prospectively enrolled 3,681 patients with suspected AMI and stratified those by the presence of DM. The ESC 0/1-h and 0/3-h algorithms were used to calculate negative and positive predictive values (NPV, PPV). In addition, alternative cutoffs were calculated and externally validated in 2,895 patients.RESULTS: In total, 563 patients (15.3%) had DM, and 137 (24.3%) of these had AMI. When the ESC 0/1-h algorithm was used, the NPV was comparable in patients with and without DM (absolute difference [AD] -1.50 [95% CI -5.95, 2.96]). In contrast, the ESC 0/3-h algorithm resulted in a significantly lower NPV in patients with DM (AD -2.27 [95% CI -4.47, -0.07]). The diagnostic performance for rule-in of AMI (PPV) was comparable in both groups: 0/1-h (AD 6.59 [95% CI -19.53, 6.35]) and 0/3-h (AD 1.03 [95% CI -7.63, 9.7]). Alternative cutoffs increased the PPV in both algorithms significantly, while improvements in NPV were only subtle.CONCLUSIONS: Application of the ESC 0/1-h algorithm revealed comparable safety to rule out AMI comparing patients with and without DM, while this was not observed with the ESC 0/3-h algorithm. Although alternative cutoffs might be helpful, patients with DM remain a high-risk population in whom identification of AMI is challenging and who require careful clinical evaluation.

AB - OBJECTIVE: Patients with diabetes mellitus (DM) have elevated levels of high-sensitivity cardiac troponin (hs-cTn). We investigated the diagnostic performance of the European Society of Cardiology (ESC) algorithms to rule out or rule in acute myocardial infarction (AMI) without ST-elevation in patients with DM.RESEARCH DESIGN AND METHODS: We prospectively enrolled 3,681 patients with suspected AMI and stratified those by the presence of DM. The ESC 0/1-h and 0/3-h algorithms were used to calculate negative and positive predictive values (NPV, PPV). In addition, alternative cutoffs were calculated and externally validated in 2,895 patients.RESULTS: In total, 563 patients (15.3%) had DM, and 137 (24.3%) of these had AMI. When the ESC 0/1-h algorithm was used, the NPV was comparable in patients with and without DM (absolute difference [AD] -1.50 [95% CI -5.95, 2.96]). In contrast, the ESC 0/3-h algorithm resulted in a significantly lower NPV in patients with DM (AD -2.27 [95% CI -4.47, -0.07]). The diagnostic performance for rule-in of AMI (PPV) was comparable in both groups: 0/1-h (AD 6.59 [95% CI -19.53, 6.35]) and 0/3-h (AD 1.03 [95% CI -7.63, 9.7]). Alternative cutoffs increased the PPV in both algorithms significantly, while improvements in NPV were only subtle.CONCLUSIONS: Application of the ESC 0/1-h algorithm revealed comparable safety to rule out AMI comparing patients with and without DM, while this was not observed with the ESC 0/3-h algorithm. Although alternative cutoffs might be helpful, patients with DM remain a high-risk population in whom identification of AMI is challenging and who require careful clinical evaluation.

KW - Aged

KW - Algorithms

KW - Arrhythmias, Cardiac/complications

KW - Biomarkers/analysis

KW - Cardiology/organization & administration

KW - Cohort Studies

KW - Diabetes Mellitus/blood

KW - Diabetic Angiopathies/diagnosis

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/blood

KW - Predictive Value of Tests

KW - Prospective Studies

KW - Risk Factors

KW - Societies, Medical/standards

KW - Time Factors

KW - Troponin I/analysis

U2 - 10.2337/dc19-1327

DO - 10.2337/dc19-1327

M3 - SCORING: Journal article

C2 - 31843947

VL - 43

SP - 460

EP - 467

JO - DIABETES CARE

JF - DIABETES CARE

SN - 0149-5992

IS - 2

ER -