RT Journal Article
SR Electronic
T1 Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E243
OP E252
DO 10.1503/cmaj.141349
VO 187
IS 8
A1 Reichlin, Tobias
A1 Twerenbold, Raphael
A1 Wildi, Karin
A1 Gimenez, Maria Rubini
A1 Bergsma, Nathalie
A1 Haaf, Philip
A1 Druey, Sophie
A1 Puelacher, Christian
A1 Moehring, Berit
A1 Freese, Michael
A1 Stelzig, Claudia
A1 Krivoshei, Lian
A1 Hillinger, Petra
A1 Jäger, Cedric
A1 Herrmann, Thomas
A1 Kreutzinger, Philip
A1 Radosavac, Milos
A1 Weidmann, Zoraida Moreno
A1 Pershyna, Kateryna
A1 Honegger, Ursina
A1 Wagener, Max
A1 Vuillomenet, Thierry
A1 Campodarve, Isabel
A1 Bingisser, Roland
A1 Miró, Òscar
A1 Rentsch, Katharina
A1 Bassetti, Stefano
A1 Osswald, Stefan
A1 Mueller, Christian
YR 2015
UL http://www.cmaj.ca/content/187/8/E243.abstract
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