Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay
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Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay. / Reichlin, Tobias; Twerenbold, Raphael; Wildi, Karin; Rubini Gimenez, Maria; Bergsma, Nathalie; Haaf, Philip; Druey, Sophie; Puelacher, Christian; Moehring, Berit; Freese, Michael; Stelzig, Claudia; Krivoshei, Lian; Hillinger, Petra; Jäger, Cedric; Herrmann, Thomas; Kreutzinger, Philip; Radosavac, Milos; Weidmann, Zoraida M.oreno; Pershyna, Kateryna; Honegger, Ursina; Wagener, Max; Vuillomenet, Thierry; Campodarve, Isabel; Bingisser, Roland; Miró, Òscar; Rentsch, Katharina; Bassetti, Stefano; Osswald, Stefan; Mueller, Christian.
In: CAN MED ASSOC J, Vol. 187, No. 8, 19.05.2015, p. E243-E252.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay
AU - Reichlin, Tobias
AU - Twerenbold, Raphael
AU - Wildi, Karin
AU - Rubini Gimenez, Maria
AU - Bergsma, Nathalie
AU - Haaf, Philip
AU - Druey, Sophie
AU - Puelacher, Christian
AU - Moehring, Berit
AU - Freese, Michael
AU - Stelzig, Claudia
AU - Krivoshei, Lian
AU - Hillinger, Petra
AU - Jäger, Cedric
AU - Herrmann, Thomas
AU - Kreutzinger, Philip
AU - Radosavac, Milos
AU - Weidmann, Zoraida M.oreno
AU - Pershyna, Kateryna
AU - Honegger, Ursina
AU - Wagener, Max
AU - Vuillomenet, Thierry
AU - Campodarve, Isabel
AU - Bingisser, Roland
AU - Miró, Òscar
AU - Rentsch, Katharina
AU - Bassetti, Stefano
AU - Osswald, Stefan
AU - Mueller, Christian
N1 - Publisher Copyright: © 2015 Canadian Medical Association or its licensors.
PY - 2015/5/19
Y1 - 2015/5/19
N2 - BACKGROUND: We aimed to prospectively validate a novel 1-hour algorithm using high-sensitivity cardiac troponin T measurement for early rule-out and rule-in of acute myocardial infarction (MI).METHODS: In a multicentre study, we enrolled 1320 patients presenting to the emergency department with suspected acute MI. The high-sensitivity cardiac troponin T 1-hour algorithm, incorporating baseline values as well as absolute changes within the first hour, was validated against the final diagnosis. The final diagnosis was then adjudicated by 2 independent cardiologists using all available information, including coronary angiography, echocardiography, follow-up data and serial measurements of high-sensitivity cardiac troponin T levels.RESULTS: Acute MI was the final diagnosis in 17.3% of patients. With application of the high-sensitivity cardiac troponin T 1-hour algorithm, 786 (59.5%) patients were classified as "rule-out," 216 (16.4%) were classified as "rule-in" and 318 (24.1%) were classified to the "observational zone." The sensitivity and the negative predictive value for acute MI in the rule-out zone were 99.6% (95% confidence interval [CI] 97.6%-99.9%) and 99.9% (95% CI 99.3%-100%), respectively. The specificity and the positive predictive value for acute MI in the rule-in zone were 95.7% (95% CI 94.3%-96.8%) and 78.2% (95% CI 72.1%-83.6%), respectively. The 1-hour algorithm provided higher negative and positive predictive values than the standard interpretation of highsensitivity cardiac troponin T using a single cut-off level (both p < 0.05). Cumulative 30-day mortality was 0.0%, 1.6% and 1.9% in patients classified in the rule-out, observational and rule-in groups, respectively (p = 0.001).INTERPRETATION: This rapid strategy incorporating high-sensitivity cardiac troponin T baseline values and absolute changes within the first hour substantially accelerated the management of suspected acute MI by allowing safe rule-out as well as accurate rule-in of acute MI in 3 out of 4 patients.TRIAL REGISTRATION: ClinicalTrials.gov, NCT00470587.
AB - BACKGROUND: We aimed to prospectively validate a novel 1-hour algorithm using high-sensitivity cardiac troponin T measurement for early rule-out and rule-in of acute myocardial infarction (MI).METHODS: In a multicentre study, we enrolled 1320 patients presenting to the emergency department with suspected acute MI. The high-sensitivity cardiac troponin T 1-hour algorithm, incorporating baseline values as well as absolute changes within the first hour, was validated against the final diagnosis. The final diagnosis was then adjudicated by 2 independent cardiologists using all available information, including coronary angiography, echocardiography, follow-up data and serial measurements of high-sensitivity cardiac troponin T levels.RESULTS: Acute MI was the final diagnosis in 17.3% of patients. With application of the high-sensitivity cardiac troponin T 1-hour algorithm, 786 (59.5%) patients were classified as "rule-out," 216 (16.4%) were classified as "rule-in" and 318 (24.1%) were classified to the "observational zone." The sensitivity and the negative predictive value for acute MI in the rule-out zone were 99.6% (95% confidence interval [CI] 97.6%-99.9%) and 99.9% (95% CI 99.3%-100%), respectively. The specificity and the positive predictive value for acute MI in the rule-in zone were 95.7% (95% CI 94.3%-96.8%) and 78.2% (95% CI 72.1%-83.6%), respectively. The 1-hour algorithm provided higher negative and positive predictive values than the standard interpretation of highsensitivity cardiac troponin T using a single cut-off level (both p < 0.05). Cumulative 30-day mortality was 0.0%, 1.6% and 1.9% in patients classified in the rule-out, observational and rule-in groups, respectively (p = 0.001).INTERPRETATION: This rapid strategy incorporating high-sensitivity cardiac troponin T baseline values and absolute changes within the first hour substantially accelerated the management of suspected acute MI by allowing safe rule-out as well as accurate rule-in of acute MI in 3 out of 4 patients.TRIAL REGISTRATION: ClinicalTrials.gov, NCT00470587.
UR - http://www.scopus.com/inward/record.url?scp=84964696078&partnerID=8YFLogxK
U2 - 10.1503/cmaj.141349
DO - 10.1503/cmaj.141349
M3 - SCORING: Journal article
C2 - 25869867
AN - SCOPUS:84964696078
VL - 187
SP - E243-E252
JO - CAN MED ASSOC J
JF - CAN MED ASSOC J
SN - 0820-3946
IS - 8
ER -