PT  - JOURNAL ARTICLE
AU  - Reichlin, Tobias
AU  - Twerenbold, Raphael
AU  - Wildi, Karin
AU  - Gimenez, Maria Rubini
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 Moreno
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
TI  - Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay
AID  - 10.1503/cmaj.141349
DP  - 2015 May 19
TA  - Canadian Medical Association Journal
PG  - E243--E252
VI  - 187
IP  - 8
4099  - http://www.cmaj.ca/content/187/8/E243.short
4100  - http://www.cmaj.ca/content/187/8/E243.full
SO  - CMAJ2015 May 19; 187
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