Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction with High-Sensitivity Cardiac Troponin T Presented at the European Society of Cardiology annual meeting, September 2014, Barcelona, Spain
Mueller, Christian (University Hospital Basel (Basilea, Suïssa))
Giannitsis, Evangelos (Heidelberg University Hospital (Alemanya))
Christ, Michael (Paracelsus Medical University)
Ordóñez, J. (Jordi) 1952- (Institut d'Investigació Biomèdica Sant Pau)
Defilippi, Christopher (University of Maryland)
McCord, James (Henry Ford Health System)
Body, Richard (Central Manchester University Hospitals NHS Foundation Trust)
Panteghini, Mauro (University of Milan Medical School)
Jernberg, Tomas (Karolinska Institutet (Estocolm, Suècia))
Plebani, Mario (University Hospital of Padova (Pàdua, Itàlia))
Verschuren, Franck (Université Catholique de Louvain)
French, John (Liverpool Hospital and University of New South Wales)
Christenson, Robert (University of Maryland)
Weiser, Silvia (Roche Diagnostics Germany)
Bendig, Garnet (Roche Diagnostics Germany)
Dilba, Peter (Roche Diagnostics Germany)
Lindahl, Bertil (Uppsala University)
Twerenbold, Raphael
Katus, Hugo A.
Popp, Steffen
Santalo-Bel, Miquel (Institut d'Investigació Biomèdica Sant Pau)
Nowak, Richard M.
Horner, Daniel
Dolci, Alberto
Zaninotto, Martina
Manara, Alessandro
Menassanch-Volker, Sylvie
Jarausch, Jochen
Zaugg, Christian
Universitat Autònoma de Barcelona

Data:	2016
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	Annals of Emergency Medicine, Vol. 68 Núm. 1 (january 2016) , p. 76-87.e4, ISSN 1097-6760

DOI: 10.1016/j.annemergmed.2015.11.013

16 p, 1.1 MB

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