Multicenter evaluation of a 0-hour/1-hour algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T
Articolo
Data di Pubblicazione:
2016
Citazione:
Multicenter evaluation of a 0-hour/1-hour algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T / C. Mueller, E. Giannitsis, M. Christ, J. Ordóñez Llanos, C. Defilippi, J. Mccord, R. Body, M. Panteghini, T. Jernberg, M. Plebani, F. Verschuren, J. French, R. Christenson, S. Weiser, G. Bendig, P. Dilba, B. Lindahl. - In: ANNALS OF EMERGENCY MEDICINE. - ISSN 0196-0644. - 68:1(2016 Jul), pp. 76-87. [10.1016/j.annemergmed.2015.11.013]
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 D1 hour below 3 ng/L to rule out; hs-cTnT at least 52 ng/L or D1 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. [Ann Emerg Med. 2016;68:76-87.]
Tipologia IRIS:
01 - Articolo su periodico
Elenco autori:
C. Mueller, E. Giannitsis, M. Christ, J. Ordóñez Llanos, C. Defilippi, J. Mccord, R. Body, M. Panteghini, T. Jernberg, M. Plebani, F. Verschuren, J. French, R. Christenson, S. Weiser, G. Bendig, P. Dilba, B. Lindahl
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