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Safety and efficacy of the 0 h/3 h protocol for rapid rule out of myocardial infarction

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Safety and efficacy of the 0 h/3 h protocol for rapid rule out of myocardial infarction. / Wildi, Karin; Nelles, Berit; Twerenbold, Raphael; Rubini Giménez, Maria; Reichlin, Tobias; Singeisen, Hélène; Druey, Sophie; Haaf, Philip; Sabti, Zaid; Hillinger, Petra; Jaeger, Cedric; Campodarve, Isabel; Kreutzinger, Philip; Puelacher, Christian; Moreno Weidmann, Zoraida; Gugala, Mathias; Pretre, Gilles; Doerflinger, Stephanie; Wagener, Max; Stallone, Fabio; Freese, Michael; Stelzig, Claudia; Rentsch, Katharina; Bassetti, Stefano; Bingisser, Roland; Osswald, Stefan; Mueller, Christian.

In: AM HEART J, Vol. 181, 11.2016, p. 16-25.

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

Harvard

Wildi, K, Nelles, B, Twerenbold, R, Rubini Giménez, M, Reichlin, T, Singeisen, H, Druey, S, Haaf, P, Sabti, Z, Hillinger, P, Jaeger, C, Campodarve, I, Kreutzinger, P, Puelacher, C, Moreno Weidmann, Z, Gugala, M, Pretre, G, Doerflinger, S, Wagener, M, Stallone, F, Freese, M, Stelzig, C, Rentsch, K, Bassetti, S, Bingisser, R, Osswald, S & Mueller, C 2016, 'Safety and efficacy of the 0 h/3 h protocol for rapid rule out of myocardial infarction', AM HEART J, vol. 181, pp. 16-25. https://doi.org/10.1016/j.ahj.2016.07.013

APA

Wildi, K., Nelles, B., Twerenbold, R., Rubini Giménez, M., Reichlin, T., Singeisen, H., Druey, S., Haaf, P., Sabti, Z., Hillinger, P., Jaeger, C., Campodarve, I., Kreutzinger, P., Puelacher, C., Moreno Weidmann, Z., Gugala, M., Pretre, G., Doerflinger, S., Wagener, M., ... Mueller, C. (2016). Safety and efficacy of the 0 h/3 h protocol for rapid rule out of myocardial infarction. AM HEART J, 181, 16-25. https://doi.org/10.1016/j.ahj.2016.07.013

Vancouver

Wildi K, Nelles B, Twerenbold R, Rubini Giménez M, Reichlin T, Singeisen H et al. Safety and efficacy of the 0 h/3 h protocol for rapid rule out of myocardial infarction. AM HEART J. 2016 Nov;181:16-25. https://doi.org/10.1016/j.ahj.2016.07.013

Bibtex

@article{eec6d44f0608460aaacf1533dbda0d0b,
title = "Safety and efficacy of the 0 h/3 h protocol for rapid rule out of myocardial infarction",
abstract = "BACKGROUND: The early and accurate diagnosis of acute myocardial infarction (AMI) is an important medical and economic challenge. We aimed to prospectively evaluate the performance of the new European Society of Cardiology rapid 0-hour/3-hour (0 h/3 h) rule out protocol for AMI.METHODS: We enrolled 2,727 consecutive patients presenting with suspected AMI without persistent ST-segment elevation to the emergency department in a prospective international multicenter study. The final diagnosis was adjudicated by 2 independent cardiologists. The performance of the 0 h/3 h rule out protocol was evaluated using 4 high-sensitivity (primary analysis) and 3 sensitive cardiac troponin (cTn) assays.RESULTS: Acute myocardial infarction was the final diagnosis in 473 patients (17.3%). Using the 4 high-sensitivity cTn assays, the 0-hour rule out protocol correctly ruled out 99.8% (95% [confidence interval] CI, 98.7%-100%), 99.6% (95% CI, 98.5%-99.9%), 100% (95% CI, 97.9%-100%), and 100% (95% CI, 98.0%-100%) of late presenters (>6 h from chest pain onset). The 3-hour rule out protocol correctly ruled out 99.9% (95% CI, 99.1%-100%), 99.5% (95% CI, 98.3%-99.9%), 100% (95% CI, 98.1%-100%), and 100% (95% CI, 98.2%-100%) of early presenters (<6 h from chest pain onset). Using the 3 sensitive cTn assays, the 0-hour rule out protocol correctly ruled out 99.6% (95% CI, 98.6%-99.9%), 99.0% (95% CI, 96.9%-99.7%), and 99.1% (95% CI, 97.2%-99.8%) of late presenters; and the 3-hour rule out protocol correctly ruled out 99.4% (95% CI, 98.3%-99.8%), 99.2% (95% CI, 97.3%-99.8%), and 99.0% (95% CI, 97.2%-99.7%) of early presenters. Overall, the 0 h/3 h rule out protocol assigned 40% to 60% of patients to rule out. None of the patients assigned rule out died during 3-months follow-up.CONCLUSIONS: The 0 h/3 h rule out protocol seems to allow the accurate rule out of AMI using both high-sensitivity and sensitive cTn measurements in conjunction with clinical assessment. Additional studies are warranted for external validation.",
keywords = "Aged, Aged, 80 and over, Chest Pain/blood, Clinical Protocols, Electrocardiography, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Myocardial Infarction/blood, Prospective Studies, Time Factors, Troponin I/blood, Troponin T/blood",
author = "Karin Wildi and Berit Nelles and Raphael Twerenbold and {Rubini Gim{\'e}nez}, Maria and Tobias Reichlin and H{\'e}l{\`e}ne Singeisen and Sophie Druey and Philip Haaf and Zaid Sabti and Petra Hillinger and Cedric Jaeger and Isabel Campodarve and Philip Kreutzinger and Christian Puelacher and {Moreno Weidmann}, Zoraida and Mathias Gugala and Gilles Pretre and Stephanie Doerflinger and Max Wagener and Fabio Stallone and Michael Freese and Claudia Stelzig and Katharina Rentsch and Stefano Bassetti and Roland Bingisser and Stefan Osswald and Christian Mueller",
note = "Copyright {\textcopyright} 2016 Elsevier Inc. All rights reserved.",
year = "2016",
month = nov,
doi = "10.1016/j.ahj.2016.07.013",
language = "English",
volume = "181",
pages = "16--25",
journal = "AM HEART J",
issn = "0002-8703",
publisher = "Mosby Inc.",

}

RIS

TY - JOUR

T1 - Safety and efficacy of the 0 h/3 h protocol for rapid rule out of myocardial infarction

AU - Wildi, Karin

AU - Nelles, Berit

AU - Twerenbold, Raphael

AU - Rubini Giménez, Maria

AU - Reichlin, Tobias

AU - Singeisen, Hélène

AU - Druey, Sophie

AU - Haaf, Philip

AU - Sabti, Zaid

AU - Hillinger, Petra

AU - Jaeger, Cedric

AU - Campodarve, Isabel

AU - Kreutzinger, Philip

AU - Puelacher, Christian

AU - Moreno Weidmann, Zoraida

AU - Gugala, Mathias

AU - Pretre, Gilles

AU - Doerflinger, Stephanie

AU - Wagener, Max

AU - Stallone, Fabio

AU - Freese, Michael

AU - Stelzig, Claudia

AU - Rentsch, Katharina

AU - Bassetti, Stefano

AU - Bingisser, Roland

AU - Osswald, Stefan

AU - Mueller, Christian

N1 - Copyright © 2016 Elsevier Inc. All rights reserved.

PY - 2016/11

Y1 - 2016/11

N2 - BACKGROUND: The early and accurate diagnosis of acute myocardial infarction (AMI) is an important medical and economic challenge. We aimed to prospectively evaluate the performance of the new European Society of Cardiology rapid 0-hour/3-hour (0 h/3 h) rule out protocol for AMI.METHODS: We enrolled 2,727 consecutive patients presenting with suspected AMI without persistent ST-segment elevation to the emergency department in a prospective international multicenter study. The final diagnosis was adjudicated by 2 independent cardiologists. The performance of the 0 h/3 h rule out protocol was evaluated using 4 high-sensitivity (primary analysis) and 3 sensitive cardiac troponin (cTn) assays.RESULTS: Acute myocardial infarction was the final diagnosis in 473 patients (17.3%). Using the 4 high-sensitivity cTn assays, the 0-hour rule out protocol correctly ruled out 99.8% (95% [confidence interval] CI, 98.7%-100%), 99.6% (95% CI, 98.5%-99.9%), 100% (95% CI, 97.9%-100%), and 100% (95% CI, 98.0%-100%) of late presenters (>6 h from chest pain onset). The 3-hour rule out protocol correctly ruled out 99.9% (95% CI, 99.1%-100%), 99.5% (95% CI, 98.3%-99.9%), 100% (95% CI, 98.1%-100%), and 100% (95% CI, 98.2%-100%) of early presenters (<6 h from chest pain onset). Using the 3 sensitive cTn assays, the 0-hour rule out protocol correctly ruled out 99.6% (95% CI, 98.6%-99.9%), 99.0% (95% CI, 96.9%-99.7%), and 99.1% (95% CI, 97.2%-99.8%) of late presenters; and the 3-hour rule out protocol correctly ruled out 99.4% (95% CI, 98.3%-99.8%), 99.2% (95% CI, 97.3%-99.8%), and 99.0% (95% CI, 97.2%-99.7%) of early presenters. Overall, the 0 h/3 h rule out protocol assigned 40% to 60% of patients to rule out. None of the patients assigned rule out died during 3-months follow-up.CONCLUSIONS: The 0 h/3 h rule out protocol seems to allow the accurate rule out of AMI using both high-sensitivity and sensitive cTn measurements in conjunction with clinical assessment. Additional studies are warranted for external validation.

AB - BACKGROUND: The early and accurate diagnosis of acute myocardial infarction (AMI) is an important medical and economic challenge. We aimed to prospectively evaluate the performance of the new European Society of Cardiology rapid 0-hour/3-hour (0 h/3 h) rule out protocol for AMI.METHODS: We enrolled 2,727 consecutive patients presenting with suspected AMI without persistent ST-segment elevation to the emergency department in a prospective international multicenter study. The final diagnosis was adjudicated by 2 independent cardiologists. The performance of the 0 h/3 h rule out protocol was evaluated using 4 high-sensitivity (primary analysis) and 3 sensitive cardiac troponin (cTn) assays.RESULTS: Acute myocardial infarction was the final diagnosis in 473 patients (17.3%). Using the 4 high-sensitivity cTn assays, the 0-hour rule out protocol correctly ruled out 99.8% (95% [confidence interval] CI, 98.7%-100%), 99.6% (95% CI, 98.5%-99.9%), 100% (95% CI, 97.9%-100%), and 100% (95% CI, 98.0%-100%) of late presenters (>6 h from chest pain onset). The 3-hour rule out protocol correctly ruled out 99.9% (95% CI, 99.1%-100%), 99.5% (95% CI, 98.3%-99.9%), 100% (95% CI, 98.1%-100%), and 100% (95% CI, 98.2%-100%) of early presenters (<6 h from chest pain onset). Using the 3 sensitive cTn assays, the 0-hour rule out protocol correctly ruled out 99.6% (95% CI, 98.6%-99.9%), 99.0% (95% CI, 96.9%-99.7%), and 99.1% (95% CI, 97.2%-99.8%) of late presenters; and the 3-hour rule out protocol correctly ruled out 99.4% (95% CI, 98.3%-99.8%), 99.2% (95% CI, 97.3%-99.8%), and 99.0% (95% CI, 97.2%-99.7%) of early presenters. Overall, the 0 h/3 h rule out protocol assigned 40% to 60% of patients to rule out. None of the patients assigned rule out died during 3-months follow-up.CONCLUSIONS: The 0 h/3 h rule out protocol seems to allow the accurate rule out of AMI using both high-sensitivity and sensitive cTn measurements in conjunction with clinical assessment. Additional studies are warranted for external validation.

KW - Aged

KW - Aged, 80 and over

KW - Chest Pain/blood

KW - Clinical Protocols

KW - Electrocardiography

KW - Emergency Service, Hospital

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/blood

KW - Prospective Studies

KW - Time Factors

KW - Troponin I/blood

KW - Troponin T/blood

U2 - 10.1016/j.ahj.2016.07.013

DO - 10.1016/j.ahj.2016.07.013

M3 - SCORING: Journal article

C2 - 27823689

VL - 181

SP - 16

EP - 25

JO - AM HEART J

JF - AM HEART J

SN - 0002-8703

ER -