Multicenter evaluation of a 0-h/1-h algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T

• Verfasst von: Müller, Christian [VerfasserIn]
• Verfasst von: Giannitsis, Evangelos [VerfasserIn]
• Titel: Multicenter evaluation of a 0-h/1-h algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T
• Verf.angabe: 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
• Umfang: 16 S.
• Fussnoten: Gesehen am 09.02.2018
• Titel Quelle: Enthalten in: Annals of emergency medicine
• Jahr Quelle: 2016
• Band/Heft Quelle: 68(2016), 1, S. 76-87.e4
• ISSN Quelle: 1097-6760
• DOI: doi:10.1016/j.annemergmed.2015.11.013
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1569138885

Abstract

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.