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Early rule-out and rule-in of myocardial infarction using sensitive cardiac Troponin I
Abstract Background It is currently unknown, whether and to what extent sensitive cardiac troponin (s-cTn) allows shortening of the time required for safe rule-out and rule-in of acute myocardial infarction (AMI). Methods We aimed to develop and validate early rule-out and rule-in algorithms for AMI...
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Published in: | International journal of cardiology 2015-09, Vol.195, p.163-170 |
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creator | Druey, Sophie Wildi, Karin Twerenbold, Raphael Jaeger, Cédric Reichlin, Tobias Haaf, Philip Rubini Gimenez, Maria Puelacher, Christian Wagener, Max Radosavac, Milos Honegger, Ursina Schumacher, Carmela Delfine, Valentina Kreutzinger, Philip Herrmann, Thomas Moreno Weidmann, Zoraida Krivoshei, Lian Freese, Michael Stelzig, Claudia Isenschmid, Cyril Bassetti, Stefano Rentsch, Katharina Osswald, Stefan Mueller, Christian |
description | Abstract Background It is currently unknown, whether and to what extent sensitive cardiac troponin (s-cTn) allows shortening of the time required for safe rule-out and rule-in of acute myocardial infarction (AMI). Methods We aimed to develop and validate early rule-out and rule-in algorithms for AMI using a thoroughly-examined and commonly used s-cTnI assay in a prospective multicenter study including 2173 patients presenting to the emergency department with suspected AMI. S-cTnI was measured in a blinded fashion at 0 h, 1 h, and 2 h. The final diagnosis was centrally adjudicated by two independent cardiologists. In the derivation cohort (n = 1496), we developed 1 h- and 2 h-algorithms assigning patients to “rule-out”, “rule-in”, or “observe”. The algorithms were then prospectively validated in the validation cohort (n = 677). Results AMI was the adjudicated diagnosis in 17% of patients. After applying the s-cTnI 1 h-algorithm developed in the derivation cohort to the validation cohort, 65% of patients were classified as “rule-out”, 12% as “rule-in”, and 23% to “observe”. The negative predictive value for AMI in the “rule-out” group was 98.6% (95% CI, 96.9–99.5), the positive predictive value for AMI in the “rule-in” group 76.3% (95% CI, 65.4–85.1). Overall, 30-day mortality was 0.2% in the “rule-out” group, 1.0% in the “observe” group, and 3.0% in the “rule-in” group. Similar results were obtained for the 2 h-algorithm. Conclusion When used in conjunction with other clinical information including the ECG, a simple algorithm incorporating s-cTnI values at presentation and after 1 h (or 2 h) will allow safe rule-out and accurate rule-in of AMI in the majority of patients. |
doi_str_mv | 10.1016/j.ijcard.2015.05.079 |
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Methods We aimed to develop and validate early rule-out and rule-in algorithms for AMI using a thoroughly-examined and commonly used s-cTnI assay in a prospective multicenter study including 2173 patients presenting to the emergency department with suspected AMI. S-cTnI was measured in a blinded fashion at 0 h, 1 h, and 2 h. The final diagnosis was centrally adjudicated by two independent cardiologists. In the derivation cohort (n = 1496), we developed 1 h- and 2 h-algorithms assigning patients to “rule-out”, “rule-in”, or “observe”. The algorithms were then prospectively validated in the validation cohort (n = 677). Results AMI was the adjudicated diagnosis in 17% of patients. After applying the s-cTnI 1 h-algorithm developed in the derivation cohort to the validation cohort, 65% of patients were classified as “rule-out”, 12% as “rule-in”, and 23% to “observe”. The negative predictive value for AMI in the “rule-out” group was 98.6% (95% CI, 96.9–99.5), the positive predictive value for AMI in the “rule-in” group 76.3% (95% CI, 65.4–85.1). Overall, 30-day mortality was 0.2% in the “rule-out” group, 1.0% in the “observe” group, and 3.0% in the “rule-in” group. Similar results were obtained for the 2 h-algorithm. Conclusion When used in conjunction with other clinical information including the ECG, a simple algorithm incorporating s-cTnI values at presentation and after 1 h (or 2 h) will allow safe rule-out and accurate rule-in of AMI in the majority of patients.</description><identifier>ISSN: 0167-5273</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2015.05.079</identifier><identifier>PMID: 26043151</identifier><language>eng</language><publisher>Netherlands: Elsevier Ireland Ltd</publisher><subject>Acute myocardial infarction ; Aged ; Algorithm ; Algorithms ; Biomarkers - analysis ; Biomarkers - blood ; Cardiovascular ; cTnI ; Early Diagnosis ; Emergency Service, Hospital - statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction - blood ; Myocardial Infarction - diagnosis ; Prospective Studies ; Reproducibility of Results ; Rule-in ; Rule-out ; Time-to-Treatment - standards ; Time-to-Treatment - statistics & numerical data ; Troponin I - analysis ; Troponin I - blood</subject><ispartof>International journal of cardiology, 2015-09, Vol.195, p.163-170</ispartof><rights>The Authors</rights><rights>2015 The Authors</rights><rights>Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c463t-81d0e90580bf0bc1ce8037916bd0bac3f86294b058fede46e16114b1638bfc1c3</citedby><cites>FETCH-LOGICAL-c463t-81d0e90580bf0bc1ce8037916bd0bac3f86294b058fede46e16114b1638bfc1c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26043151$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Druey, Sophie</creatorcontrib><creatorcontrib>Wildi, Karin</creatorcontrib><creatorcontrib>Twerenbold, Raphael</creatorcontrib><creatorcontrib>Jaeger, Cédric</creatorcontrib><creatorcontrib>Reichlin, Tobias</creatorcontrib><creatorcontrib>Haaf, Philip</creatorcontrib><creatorcontrib>Rubini Gimenez, Maria</creatorcontrib><creatorcontrib>Puelacher, Christian</creatorcontrib><creatorcontrib>Wagener, Max</creatorcontrib><creatorcontrib>Radosavac, Milos</creatorcontrib><creatorcontrib>Honegger, Ursina</creatorcontrib><creatorcontrib>Schumacher, Carmela</creatorcontrib><creatorcontrib>Delfine, Valentina</creatorcontrib><creatorcontrib>Kreutzinger, Philip</creatorcontrib><creatorcontrib>Herrmann, Thomas</creatorcontrib><creatorcontrib>Moreno Weidmann, Zoraida</creatorcontrib><creatorcontrib>Krivoshei, Lian</creatorcontrib><creatorcontrib>Freese, Michael</creatorcontrib><creatorcontrib>Stelzig, Claudia</creatorcontrib><creatorcontrib>Isenschmid, Cyril</creatorcontrib><creatorcontrib>Bassetti, Stefano</creatorcontrib><creatorcontrib>Rentsch, Katharina</creatorcontrib><creatorcontrib>Osswald, Stefan</creatorcontrib><creatorcontrib>Mueller, Christian</creatorcontrib><title>Early rule-out and rule-in of myocardial infarction using sensitive cardiac Troponin I</title><title>International journal of cardiology</title><addtitle>Int J Cardiol</addtitle><description>Abstract Background It is currently unknown, whether and to what extent sensitive cardiac troponin (s-cTn) allows shortening of the time required for safe rule-out and rule-in of acute myocardial infarction (AMI). Methods We aimed to develop and validate early rule-out and rule-in algorithms for AMI using a thoroughly-examined and commonly used s-cTnI assay in a prospective multicenter study including 2173 patients presenting to the emergency department with suspected AMI. S-cTnI was measured in a blinded fashion at 0 h, 1 h, and 2 h. The final diagnosis was centrally adjudicated by two independent cardiologists. In the derivation cohort (n = 1496), we developed 1 h- and 2 h-algorithms assigning patients to “rule-out”, “rule-in”, or “observe”. The algorithms were then prospectively validated in the validation cohort (n = 677). Results AMI was the adjudicated diagnosis in 17% of patients. After applying the s-cTnI 1 h-algorithm developed in the derivation cohort to the validation cohort, 65% of patients were classified as “rule-out”, 12% as “rule-in”, and 23% to “observe”. The negative predictive value for AMI in the “rule-out” group was 98.6% (95% CI, 96.9–99.5), the positive predictive value for AMI in the “rule-in” group 76.3% (95% CI, 65.4–85.1). Overall, 30-day mortality was 0.2% in the “rule-out” group, 1.0% in the “observe” group, and 3.0% in the “rule-in” group. Similar results were obtained for the 2 h-algorithm. Conclusion When used in conjunction with other clinical information including the ECG, a simple algorithm incorporating s-cTnI values at presentation and after 1 h (or 2 h) will allow safe rule-out and accurate rule-in of AMI in the majority of patients.</description><subject>Acute myocardial infarction</subject><subject>Aged</subject><subject>Algorithm</subject><subject>Algorithms</subject><subject>Biomarkers - analysis</subject><subject>Biomarkers - blood</subject><subject>Cardiovascular</subject><subject>cTnI</subject><subject>Early Diagnosis</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - blood</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Prospective Studies</subject><subject>Reproducibility of Results</subject><subject>Rule-in</subject><subject>Rule-out</subject><subject>Time-to-Treatment - standards</subject><subject>Time-to-Treatment - statistics & numerical data</subject><subject>Troponin I - analysis</subject><subject>Troponin I - blood</subject><issn>0167-5273</issn><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNqFkUFr3DAQhUVoSTZp_0EpOvbi7Ywly_alUEKaBAI9NO1VyPK4yPVKW8kO7L-vjJMeeikMDAPfm8e8Yewdwh4B1cdx70ZrYr8vAas95KrbM7bDppYF1pV8xXYZq4uqrMUFu0xpBADZts05uygVSIEV7tiPGxOnE4_LREVYZm58vw3O8zDwwymsHs5M3PnBRDu74PmSnP_JE_nkZvdEfEMsf4zhGHxW3r9hrwczJXr73K_Y9y83j9d3xcPX2_vrzw-FlUrMRYM9UAtVA90AnUVLDYi6RdX10BkrhkaVrewyMFBPUhEqRNmhEk03ZFxcsQ_b3mMMvxdKsz64ZGmajKewJI2qBVUhiDajckNtDClFGvQxuoOJJ42g10T1qLdE9Zqohlz1Knv_7LB0B-r_il4izMCnDaB855OjqJN15C31LpKddR_c_xz-XWAn55010y86URrDEn3OUKNOpQb9bf3q-lSsAFGoSvwBiUWd_Q</recordid><startdate>20150915</startdate><enddate>20150915</enddate><creator>Druey, Sophie</creator><creator>Wildi, Karin</creator><creator>Twerenbold, Raphael</creator><creator>Jaeger, Cédric</creator><creator>Reichlin, Tobias</creator><creator>Haaf, Philip</creator><creator>Rubini Gimenez, Maria</creator><creator>Puelacher, Christian</creator><creator>Wagener, Max</creator><creator>Radosavac, Milos</creator><creator>Honegger, Ursina</creator><creator>Schumacher, Carmela</creator><creator>Delfine, Valentina</creator><creator>Kreutzinger, Philip</creator><creator>Herrmann, Thomas</creator><creator>Moreno Weidmann, Zoraida</creator><creator>Krivoshei, Lian</creator><creator>Freese, Michael</creator><creator>Stelzig, Claudia</creator><creator>Isenschmid, Cyril</creator><creator>Bassetti, Stefano</creator><creator>Rentsch, Katharina</creator><creator>Osswald, Stefan</creator><creator>Mueller, Christian</creator><general>Elsevier Ireland Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150915</creationdate><title>Early rule-out and rule-in of myocardial infarction using sensitive cardiac Troponin I</title><author>Druey, Sophie ; Wildi, Karin ; Twerenbold, Raphael ; Jaeger, Cédric ; Reichlin, Tobias ; Haaf, Philip ; Rubini Gimenez, Maria ; Puelacher, Christian ; Wagener, Max ; Radosavac, Milos ; Honegger, Ursina ; Schumacher, Carmela ; Delfine, Valentina ; Kreutzinger, Philip ; Herrmann, Thomas ; Moreno Weidmann, Zoraida ; Krivoshei, Lian ; Freese, Michael ; Stelzig, Claudia ; Isenschmid, Cyril ; Bassetti, Stefano ; Rentsch, Katharina ; Osswald, Stefan ; Mueller, Christian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c463t-81d0e90580bf0bc1ce8037916bd0bac3f86294b058fede46e16114b1638bfc1c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Acute myocardial infarction</topic><topic>Aged</topic><topic>Algorithm</topic><topic>Algorithms</topic><topic>Biomarkers - analysis</topic><topic>Biomarkers - blood</topic><topic>Cardiovascular</topic><topic>cTnI</topic><topic>Early Diagnosis</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - blood</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Prospective Studies</topic><topic>Reproducibility of Results</topic><topic>Rule-in</topic><topic>Rule-out</topic><topic>Time-to-Treatment - standards</topic><topic>Time-to-Treatment - statistics & numerical data</topic><topic>Troponin I - analysis</topic><topic>Troponin I - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Druey, Sophie</creatorcontrib><creatorcontrib>Wildi, Karin</creatorcontrib><creatorcontrib>Twerenbold, Raphael</creatorcontrib><creatorcontrib>Jaeger, Cédric</creatorcontrib><creatorcontrib>Reichlin, Tobias</creatorcontrib><creatorcontrib>Haaf, Philip</creatorcontrib><creatorcontrib>Rubini Gimenez, Maria</creatorcontrib><creatorcontrib>Puelacher, Christian</creatorcontrib><creatorcontrib>Wagener, Max</creatorcontrib><creatorcontrib>Radosavac, Milos</creatorcontrib><creatorcontrib>Honegger, Ursina</creatorcontrib><creatorcontrib>Schumacher, Carmela</creatorcontrib><creatorcontrib>Delfine, Valentina</creatorcontrib><creatorcontrib>Kreutzinger, Philip</creatorcontrib><creatorcontrib>Herrmann, Thomas</creatorcontrib><creatorcontrib>Moreno Weidmann, Zoraida</creatorcontrib><creatorcontrib>Krivoshei, Lian</creatorcontrib><creatorcontrib>Freese, Michael</creatorcontrib><creatorcontrib>Stelzig, Claudia</creatorcontrib><creatorcontrib>Isenschmid, Cyril</creatorcontrib><creatorcontrib>Bassetti, Stefano</creatorcontrib><creatorcontrib>Rentsch, Katharina</creatorcontrib><creatorcontrib>Osswald, Stefan</creatorcontrib><creatorcontrib>Mueller, Christian</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Druey, Sophie</au><au>Wildi, Karin</au><au>Twerenbold, Raphael</au><au>Jaeger, Cédric</au><au>Reichlin, Tobias</au><au>Haaf, Philip</au><au>Rubini Gimenez, Maria</au><au>Puelacher, Christian</au><au>Wagener, Max</au><au>Radosavac, Milos</au><au>Honegger, Ursina</au><au>Schumacher, Carmela</au><au>Delfine, Valentina</au><au>Kreutzinger, Philip</au><au>Herrmann, Thomas</au><au>Moreno Weidmann, Zoraida</au><au>Krivoshei, Lian</au><au>Freese, Michael</au><au>Stelzig, Claudia</au><au>Isenschmid, Cyril</au><au>Bassetti, Stefano</au><au>Rentsch, Katharina</au><au>Osswald, Stefan</au><au>Mueller, Christian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early rule-out and rule-in of myocardial infarction using sensitive cardiac Troponin I</atitle><jtitle>International journal of cardiology</jtitle><addtitle>Int J Cardiol</addtitle><date>2015-09-15</date><risdate>2015</risdate><volume>195</volume><spage>163</spage><epage>170</epage><pages>163-170</pages><issn>0167-5273</issn><eissn>1874-1754</eissn><abstract>Abstract Background It is currently unknown, whether and to what extent sensitive cardiac troponin (s-cTn) allows shortening of the time required for safe rule-out and rule-in of acute myocardial infarction (AMI). Methods We aimed to develop and validate early rule-out and rule-in algorithms for AMI using a thoroughly-examined and commonly used s-cTnI assay in a prospective multicenter study including 2173 patients presenting to the emergency department with suspected AMI. S-cTnI was measured in a blinded fashion at 0 h, 1 h, and 2 h. The final diagnosis was centrally adjudicated by two independent cardiologists. In the derivation cohort (n = 1496), we developed 1 h- and 2 h-algorithms assigning patients to “rule-out”, “rule-in”, or “observe”. The algorithms were then prospectively validated in the validation cohort (n = 677). Results AMI was the adjudicated diagnosis in 17% of patients. After applying the s-cTnI 1 h-algorithm developed in the derivation cohort to the validation cohort, 65% of patients were classified as “rule-out”, 12% as “rule-in”, and 23% to “observe”. The negative predictive value for AMI in the “rule-out” group was 98.6% (95% CI, 96.9–99.5), the positive predictive value for AMI in the “rule-in” group 76.3% (95% CI, 65.4–85.1). Overall, 30-day mortality was 0.2% in the “rule-out” group, 1.0% in the “observe” group, and 3.0% in the “rule-in” group. Similar results were obtained for the 2 h-algorithm. Conclusion When used in conjunction with other clinical information including the ECG, a simple algorithm incorporating s-cTnI values at presentation and after 1 h (or 2 h) will allow safe rule-out and accurate rule-in of AMI in the majority of patients.</abstract><cop>Netherlands</cop><pub>Elsevier Ireland Ltd</pub><pmid>26043151</pmid><doi>10.1016/j.ijcard.2015.05.079</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Acute myocardial infarction Aged Algorithm Algorithms Biomarkers - analysis Biomarkers - blood Cardiovascular cTnI Early Diagnosis Emergency Service, Hospital - statistics & numerical data Female Humans Male Middle Aged Myocardial Infarction - blood Myocardial Infarction - diagnosis Prospective Studies Reproducibility of Results Rule-in Rule-out Time-to-Treatment - standards Time-to-Treatment - statistics & numerical data Troponin I - analysis Troponin I - blood |
title | Early rule-out and rule-in of myocardial infarction using sensitive cardiac Troponin I |
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