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Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction

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Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction. / Twerenbold, Raphael; Neumann, Johannes Tobias; Sörensen, Nils Arne; Ojeda, Francisco; Karakas, Mahir; Boeddinghaus, Jasper; Nestelberger, Thomas; Badertscher, Patrick; Rubini Giménez, Maria; Puelacher, Christian; Wildi, Karin; Kozhuharov, Nikola; Breitenbuecher, Dominik; Biskup, Ewelina; du Fay de Lavallaz, Jeanne; Flores, Dayana; Wussler, Desiree; Miró, Òscar; Martín Sánchez, F Javier; Morawiec, Beata; Parenica, Jiri; Geigy, Nicolas; Keller, Dagmar I; Zeller, Tanja; Reichlin, Tobias; Blankenberg, Stefan; Westermann, Dirk; Mueller, Christian.

In: J AM COLL CARDIOL, Vol. 72, No. 6, 07.08.2018, p. 620-632.

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

Harvard

Twerenbold, R, Neumann, JT, Sörensen, NA, Ojeda, F, Karakas, M, Boeddinghaus, J, Nestelberger, T, Badertscher, P, Rubini Giménez, M, Puelacher, C, Wildi, K, Kozhuharov, N, Breitenbuecher, D, Biskup, E, du Fay de Lavallaz, J, Flores, D, Wussler, D, Miró, Ò, Martín Sánchez, FJ, Morawiec, B, Parenica, J, Geigy, N, Keller, DI, Zeller, T, Reichlin, T, Blankenberg, S, Westermann, D & Mueller, C 2018, 'Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction', J AM COLL CARDIOL, vol. 72, no. 6, pp. 620-632. https://doi.org/10.1016/j.jacc.2018.05.040

APA

Twerenbold, R., Neumann, J. T., Sörensen, N. A., Ojeda, F., Karakas, M., Boeddinghaus, J., Nestelberger, T., Badertscher, P., Rubini Giménez, M., Puelacher, C., Wildi, K., Kozhuharov, N., Breitenbuecher, D., Biskup, E., du Fay de Lavallaz, J., Flores, D., Wussler, D., Miró, Ò., Martín Sánchez, F. J., ... Mueller, C. (2018). Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction. J AM COLL CARDIOL, 72(6), 620-632. https://doi.org/10.1016/j.jacc.2018.05.040

Vancouver

Twerenbold R, Neumann JT, Sörensen NA, Ojeda F, Karakas M, Boeddinghaus J et al. Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction. J AM COLL CARDIOL. 2018 Aug 7;72(6):620-632. https://doi.org/10.1016/j.jacc.2018.05.040

Bibtex

@article{7d4ea8d8e81745e19399c840958d13f9,
title = "Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction",
abstract = "BACKGROUND: The safety of the European Society of Cardiology (ESC) 0/1-h algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin (hs-cTn) has been questioned.OBJECTIVES: This study aimed to validate the diagnostic performance of the 0/1-h algorithm in a large multicenter study.METHODS: The authors prospectively enrolled unselected patients in 6 countries presenting to the emergency department with symptoms suggestive of NSTEMI. Final diagnosis was centrally adjudicated by 2 independent cardiologists. Hs-cTnT and hs-cTnI blood concentrations were measured at presentation and after 1 h. Safety of rule-out was quantified by the negative predictive value (NPV) for NSTEMI, accuracy of rule-in by the positive predictive value (PPV), and overall efficacy by the proportion of patients triaged towards rule-out or rule-in within 1 h.RESULTS: Prevalence of NSTEMI was 17%. Among 4,368 patients with serial hs-cTnT measurements available, safety of rule-out (NPV 99.8%, 2,488 of 2,493), accuracy of rule-in (PPV 74.5%, 572 of 768), and overall efficacy were high by assigning three-fourths of patients either to rule-out (57%, 2,493 to 4,368) or rule-in (18%, 768 to 4,368). Similarly, among 3,500 patients with serial hs-cTnI measurements, safety of rule-out (NPV 99.7%, 1,528 of 1,533), accuracy of rule-in (PPV 62.3%, 498 of 800), and overall efficacy were high by assigning more than two-thirds of patients either to rule-out (44%, 1,533 of 3,500) or rule-in (23%, 800 of 3,500). Excellent safety was confirmed in multiple subgroup analyses including patients presenting early (≤3 h) after chest pain onset.CONCLUSIONS: The ESC 0/1-h algorithm using hs-cTnT and hs-cTnI is very safe and effective in triaging patients with suspected NSTEMI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE]; NCT00470587; and Biomarkers in Acute Cardiac Care [BACC]; NCT02355457).",
keywords = "Aged, Algorithms, Chest Pain/diagnosis, Early Diagnosis, Female, Follow-Up Studies, Humans, Internationality, Male, Middle Aged, Myocardial Infarction/diagnosis, Predictive Value of Tests, Prospective Studies, Reproducibility of Results",
author = "Raphael Twerenbold and Neumann, {Johannes Tobias} and S{\"o}rensen, {Nils Arne} and Francisco Ojeda and Mahir Karakas and Jasper Boeddinghaus and Thomas Nestelberger and Patrick Badertscher and {Rubini Gim{\'e}nez}, Maria and Christian Puelacher and Karin Wildi and Nikola Kozhuharov and Dominik Breitenbuecher and Ewelina Biskup and {du Fay de Lavallaz}, Jeanne and Dayana Flores and Desiree Wussler and {\`O}scar Mir{\'o} and {Mart{\'i}n S{\'a}nchez}, {F Javier} and Beata Morawiec and Jiri Parenica and Nicolas Geigy and Keller, {Dagmar I} and Tanja Zeller and Tobias Reichlin and Stefan Blankenberg and Dirk Westermann and Christian Mueller",
note = "Copyright {\textcopyright} 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.",
year = "2018",
month = aug,
day = "7",
doi = "10.1016/j.jacc.2018.05.040",
language = "English",
volume = "72",
pages = "620--632",
journal = "J AM COLL CARDIOL",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "6",

}

RIS

TY - JOUR

T1 - Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction

AU - Twerenbold, Raphael

AU - Neumann, Johannes Tobias

AU - Sörensen, Nils Arne

AU - Ojeda, Francisco

AU - Karakas, Mahir

AU - Boeddinghaus, Jasper

AU - Nestelberger, Thomas

AU - Badertscher, Patrick

AU - Rubini Giménez, Maria

AU - Puelacher, Christian

AU - Wildi, Karin

AU - Kozhuharov, Nikola

AU - Breitenbuecher, Dominik

AU - Biskup, Ewelina

AU - du Fay de Lavallaz, Jeanne

AU - Flores, Dayana

AU - Wussler, Desiree

AU - Miró, Òscar

AU - Martín Sánchez, F Javier

AU - Morawiec, Beata

AU - Parenica, Jiri

AU - Geigy, Nicolas

AU - Keller, Dagmar I

AU - Zeller, Tanja

AU - Reichlin, Tobias

AU - Blankenberg, Stefan

AU - Westermann, Dirk

AU - Mueller, Christian

N1 - Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PY - 2018/8/7

Y1 - 2018/8/7

N2 - BACKGROUND: The safety of the European Society of Cardiology (ESC) 0/1-h algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin (hs-cTn) has been questioned.OBJECTIVES: This study aimed to validate the diagnostic performance of the 0/1-h algorithm in a large multicenter study.METHODS: The authors prospectively enrolled unselected patients in 6 countries presenting to the emergency department with symptoms suggestive of NSTEMI. Final diagnosis was centrally adjudicated by 2 independent cardiologists. Hs-cTnT and hs-cTnI blood concentrations were measured at presentation and after 1 h. Safety of rule-out was quantified by the negative predictive value (NPV) for NSTEMI, accuracy of rule-in by the positive predictive value (PPV), and overall efficacy by the proportion of patients triaged towards rule-out or rule-in within 1 h.RESULTS: Prevalence of NSTEMI was 17%. Among 4,368 patients with serial hs-cTnT measurements available, safety of rule-out (NPV 99.8%, 2,488 of 2,493), accuracy of rule-in (PPV 74.5%, 572 of 768), and overall efficacy were high by assigning three-fourths of patients either to rule-out (57%, 2,493 to 4,368) or rule-in (18%, 768 to 4,368). Similarly, among 3,500 patients with serial hs-cTnI measurements, safety of rule-out (NPV 99.7%, 1,528 of 1,533), accuracy of rule-in (PPV 62.3%, 498 of 800), and overall efficacy were high by assigning more than two-thirds of patients either to rule-out (44%, 1,533 of 3,500) or rule-in (23%, 800 of 3,500). Excellent safety was confirmed in multiple subgroup analyses including patients presenting early (≤3 h) after chest pain onset.CONCLUSIONS: The ESC 0/1-h algorithm using hs-cTnT and hs-cTnI is very safe and effective in triaging patients with suspected NSTEMI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE]; NCT00470587; and Biomarkers in Acute Cardiac Care [BACC]; NCT02355457).

AB - BACKGROUND: The safety of the European Society of Cardiology (ESC) 0/1-h algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin (hs-cTn) has been questioned.OBJECTIVES: This study aimed to validate the diagnostic performance of the 0/1-h algorithm in a large multicenter study.METHODS: The authors prospectively enrolled unselected patients in 6 countries presenting to the emergency department with symptoms suggestive of NSTEMI. Final diagnosis was centrally adjudicated by 2 independent cardiologists. Hs-cTnT and hs-cTnI blood concentrations were measured at presentation and after 1 h. Safety of rule-out was quantified by the negative predictive value (NPV) for NSTEMI, accuracy of rule-in by the positive predictive value (PPV), and overall efficacy by the proportion of patients triaged towards rule-out or rule-in within 1 h.RESULTS: Prevalence of NSTEMI was 17%. Among 4,368 patients with serial hs-cTnT measurements available, safety of rule-out (NPV 99.8%, 2,488 of 2,493), accuracy of rule-in (PPV 74.5%, 572 of 768), and overall efficacy were high by assigning three-fourths of patients either to rule-out (57%, 2,493 to 4,368) or rule-in (18%, 768 to 4,368). Similarly, among 3,500 patients with serial hs-cTnI measurements, safety of rule-out (NPV 99.7%, 1,528 of 1,533), accuracy of rule-in (PPV 62.3%, 498 of 800), and overall efficacy were high by assigning more than two-thirds of patients either to rule-out (44%, 1,533 of 3,500) or rule-in (23%, 800 of 3,500). Excellent safety was confirmed in multiple subgroup analyses including patients presenting early (≤3 h) after chest pain onset.CONCLUSIONS: The ESC 0/1-h algorithm using hs-cTnT and hs-cTnI is very safe and effective in triaging patients with suspected NSTEMI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE]; NCT00470587; and Biomarkers in Acute Cardiac Care [BACC]; NCT02355457).

KW - Aged

KW - Algorithms

KW - Chest Pain/diagnosis

KW - Early Diagnosis

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Internationality

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/diagnosis

KW - Predictive Value of Tests

KW - Prospective Studies

KW - Reproducibility of Results

U2 - 10.1016/j.jacc.2018.05.040

DO - 10.1016/j.jacc.2018.05.040

M3 - SCORING: Journal article

C2 - 30071991

VL - 72

SP - 620

EP - 632

JO - J AM COLL CARDIOL

JF - J AM COLL CARDIOL

SN - 0735-1097

IS - 6

ER -