Multicenter evaluation of a 0-h/1-h algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T
Study objective: We aim to prospectively validate the diagnostic accuracy of the recently developed 0-h/1-h algorithm, using high-sensitivity cardiac troponin T (hs-cTnT) for the early rule-out and rule-in of acute myocardial infarction. Methods: We enrolled patients presenting with suspected acute...
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| Hauptverfasser: | , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
2016 Jan 12
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| In: |
Annals of emergency medicine
Year: 2016, Jahrgang: 68, Heft: 1, Pages: 76-87.e4 |
| ISSN: | 1097-6760 |
| DOI: | 10.1016/j.annemergmed.2015.11.013 |
| Online-Zugang: | Verlag, Volltext: http://dx.doi.org/10.1016/j.annemergmed.2015.11.013 Verlag, Volltext: http://www.sciencedirect.com/science/article/pii/S0196064415015012 
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| Verfasserangaben: | Christian Mueller, MD; Evangelos Giannitsis, MD; Michael Christ, MD; Jorge Ordóñez-Llanos, MD; Christopher deFilippi, MD; James McCord, MD; Richard Body, MB ChB, PhD; Mauro Panteghini, MD; Tomas Jernberg, MD; Mario Plebani, MD; Franck Verschuren, PhD; John French, PhD; Robert Christenson, PhD; Silvia Weiser, PhD; Garnet Bendig, PhD; Peter Dilba, Dipl Stat; Bertil Lindahl, MD; for the TRAPID-AMI Investigators |
MARC
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| 245 | 1 | 0 | |a Multicenter evaluation of a 0-h/1-h algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T |c Christian Mueller, MD; Evangelos Giannitsis, MD; Michael Christ, MD; Jorge Ordóñez-Llanos, MD; Christopher deFilippi, MD; James McCord, MD; Richard Body, MB ChB, PhD; Mauro Panteghini, MD; Tomas Jernberg, MD; Mario Plebani, MD; Franck Verschuren, PhD; John French, PhD; Robert Christenson, PhD; Silvia Weiser, PhD; Garnet Bendig, PhD; Peter Dilba, Dipl Stat; Bertil Lindahl, MD; for the TRAPID-AMI Investigators |
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| 520 | |a Study objective: We aim to prospectively validate the diagnostic accuracy of the recently developed 0-h/1-h algorithm, using high-sensitivity cardiac troponin T (hs-cTnT) for the early rule-out and rule-in of acute myocardial infarction. Methods: We enrolled patients presenting with suspected acute myocardial infarction and recent (<6 hours) onset of symptoms to the emergency department in a global multicenter diagnostic study. Hs-cTnT (Roche Diagnostics) and sensitive cardiac troponin I (Siemens Healthcare) were measured at presentation and after 1 hour, 2 hours, and 4 to 14 hours in a central laboratory. Patient triage according to the predefined hs-cTnT 0-hour/1-hour algorithm (hs-cTnT below 12 ng/L and Δ1 hour below 3 ng/L to rule out; hs-cTnT at least 52 ng/L or Δ1 hour at least 5 ng/L to rule in; remaining patients to the “observational zone”) was compared against a centrally adjudicated final diagnosis by 2 independent cardiologists (reference standard). The final diagnosis was based on all available information, including coronary angiography and echocardiography results, follow-up data, and serial measurements of sensitive cardiac troponin I, whereas adjudicators remained blinded to hs-cTnT. Results: Among 1,282 patients enrolled, acute myocardial infarction was the final diagnosis for 213 (16.6%) patients. Applying the hs-cTnT 0-hour/1-hour algorithm, 813 (63.4%) patients were classified as rule out, 184 (14.4%) were classified as rule in, and 285 (22.2%) were triaged to the observational zone. This resulted in a negative predictive value and sensitivity for acute myocardial infarction of 99.1% (95% confidence interval [CI] 98.2% to 99.7%) and 96.7% (95% CI 93.4% to 98.7%) in the rule-out zone (7 patients with false-negative results), a positive predictive value and specificity for acute myocardial infarction of 77.2% (95% CI 70.4% to 83.0%) and 96.1% (95% CI 94.7% to 97.2%) in the rule-in zone, and a prevalence of acute myocardial infarction of 22.5% in the observational zone. Conclusion: The hs-cTnT 0-hour/1-hour algorithm performs well for early rule-out and rule-in of acute myocardial infarction. | ||
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