Direct Comparison of 4 Very Early Rule-Out Strategies for Acute
Myocardial Infarction Using High-Sensitivity Cardiac Troponin I

J 2017

Direct Comparison of 4 Very Early Rule-Out Strategies for Acute Myocardial Infarction Using High-Sensitivity Cardiac Troponin I

BOEDDINGHAUS, J.; T. NESTELBERGER; R. TWERENBOLD; K. WILDI; P. BADERTSCHER et al.

Základní údaje

Originální název

Direct Comparison of 4 Very Early Rule-Out Strategies for Acute Myocardial Infarction Using High-Sensitivity Cardiac Troponin I

Autoři

Vydání

Circulation, Philadelphia, Lippincott Williams Wilkins, 2017, 0009-7322

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30201 Cardiac and Cardiovascular systems

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Impakt faktor

Impact factor: 18.881

Označené pro přenos do RIV

Ano

Kód RIV

RIV/00216224:14110/17:00097703

Organizační jednotka

Lékařská fakulta

Klíčová slova anglicky

diagnosis; myocardial infarction; rule-out strategies

Štítky

EL OK

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 21. 3. 2018 16:03, Soňa Böhmová

Anotace

V originále

BACKGROUND: Four strategies for very early rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I (hs-cTnI) have been identified. It remains unclear which strategy is most attractive for clinical application. METHODS: We prospectively enrolled unselected patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction. The final diagnosis was adjudicated by 2 independent cardiologists. Hs-cTnI levels were measured at presentation and after 1 hour in a blinded fashion. We directly compared all 4 hs-cTnI-based rule-out strategies: limit of detection (LOD, hs-cTnI<2 ng/L), single cutoff (hs-cTnI<5 ng/L), 1-hour algorithm (hs-cTnI<5 ng/L and 1-hour change<2 ng/L), and the 0/1-hour algorithm recommended in the European Society of Cardiology guideline combining LOD and 1-hour algorithm. RESULTS: Among 2828 enrolled patients, acute myocardial infarction was the final diagnosis in 451 (16%) patients. The LOD approach ruled out 453 patients (16%) with a sensitivity of 100% (95% confidence interval [CI], 99.2%-100%), the single cutoff 1516 patients (54%) with a sensitivity of 97.1% (95% CI, 95.1%-98.3%), the 1-hour algorithm 1459 patients (52%) with a sensitivity of 98.4% (95% CI, 96.8%-99.2%), and the 0/1-hour algorithm 1463 patients (52%) with a sensitivity of 98.4% (95% CI, 96.8%-99.2%). Predefined subgroup analysis in early presenters (<= 2 hours) revealed significantly lower sensitivity (94.2%, interaction P=0.03) of the single cutoff, but not the other strategies. Two-year survival was 100% with LOD and 98.1% with the other strategies (P<0.01 for LOD versus each of the other strategies). CONCLUSIONS: All 4 rule-out strategies balance effectiveness and safety equally well. The single cutoff should not be applied in early presenters, whereas the 3 other strategies seem to perform well in this challenging subgroup.

Citovat

BOEDDINGHAUS, J.; T. NESTELBERGER; R. TWERENBOLD; K. WILDI; P. BADERTSCHER; J. CUPA; T. BURGE; P. MACHLER; S. CORBIERE; K. GRIMM; M.R. GIMENEZ; C. PUELACHER; S. SHRESTHA; D.F. WIDMER; J. FUHRMANN; P. HILLINGER; Z. SABTI; U. HONEGGER; N. SCHAERLI; N. KOZHUHAROV; K. RENTSCH; O. MIRO; B. LOPEZ; F.J. MARTIN-SANCHEZ; E. RODRIGUEZ-ADRADA; B. MORAWIEC; D. KAWECKI; Eva GANOVSKÁ; Jiří PAŘENICA; J. LOHRMANN; W. KLOOS; A. BUSER; N. GEIGY; D.I. KELLER; S. OSSWALD; T. REICHLIN a C. MUELLER. Direct Comparison of 4 Very Early Rule-Out Strategies for Acute Myocardial Infarction Using High-Sensitivity Cardiac Troponin I. Circulation. Philadelphia: Lippincott Williams Wilkins, 2017, roč. 135, č. 17, s. "1597"-"+", 31 s. ISSN 0009-7322. Dostupné z: https://doi.org/10.1161/CIRCULATIONAHA.116.025661.

@article{1390863,
   author = {Boeddinghaus, J. and Nestelberger, T. and Twerenbold, R. and Wildi, K. and Badertscher, P. and Cupa, J. and Burge, T. and Machler, P. and Corbiere, S. and Grimm, K. and Gimenez, M.R. and Puelacher, C. and Shrestha, S. and Widmer, D.F. and Fuhrmann, J. and Hillinger, P. and Sabti, Z. and Honegger, U. and Schaerli, N. and Kozhuharov, N. and Rentsch, K. and Miro, O. and Lopez, B. and MartinandSanchez, F.J. and RodriguezandAdrada, E. and Morawiec, B. and Kawecki, D. and Ganovská, Eva and Pařenica, Jiří and Lohrmann, J. and Kloos, W. and Buser, A. and Geigy, N. and Keller, D.I. and Osswald, S. and Reichlin, T. and Mueller, C.},
   article_location = {Philadelphia},
   article_number = {17},
   doi = {https://doi.org/10.1161/CIRCULATIONAHA.116.025661},
   keywords = {diagnosis; myocardial infarction; rule-out strategies},
   language = {eng},
   issn = {0009-7322},
   journal = {Circulation},
   title = {Direct Comparison of 4 Very Early Rule-Out Strategies for Acute Myocardial Infarction Using High-Sensitivity Cardiac Troponin I},
   volume = {135},
   year = {2017}
}

TY  - JOUR
ID  - 1390863
AU  - Boeddinghaus, J. - Nestelberger, T. - Twerenbold, R. - Wildi, K. - Badertscher, P. - Cupa, J. - Burge, T. - Machler, P. - Corbiere, S. - Grimm, K. - Gimenez, M.R. - Puelacher, C. - Shrestha, S. - Widmer, D.F. - Fuhrmann, J. - Hillinger, P. - Sabti, Z. - Honegger, U. - Schaerli, N. - Kozhuharov, N. - Rentsch, K. - Miro, O. - Lopez, B. - Martin-Sanchez, F.J. - Rodriguez-Adrada, E. - Morawiec, B. - Kawecki, D. - Ganovská, Eva - Pařenica, Jiří - Lohrmann, J. - Kloos, W. - Buser, A. - Geigy, N. - Keller, D.I. - Osswald, S. - Reichlin, T. - Mueller, C.
PY  - 2017
TI  - Direct Comparison of 4 Very Early Rule-Out Strategies for Acute Myocardial Infarction Using High-Sensitivity Cardiac Troponin I
JF  - Circulation
VL  - 135
IS  - 17
SP  - "1597"-"+"
EP  - "1597"-"+"
PB  - Lippincott Williams Wilkins
SN  - 00097322
KW  - diagnosis
KW  - myocardial infarction
KW  - rule-out strategies
N2  - BACKGROUND: Four strategies for very early rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I (hs-cTnI) have been identified. It remains unclear which strategy is most attractive for clinical application. METHODS: We prospectively enrolled unselected patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction. The final diagnosis was adjudicated by 2 independent cardiologists. Hs-cTnI levels were measured at presentation and after 1 hour in a blinded fashion. We directly compared all 4 hs-cTnI-based rule-out strategies: limit of detection (LOD, hs-cTnI<2 ng/L), single cutoff (hs-cTnI<5 ng/L), 1-hour algorithm (hs-cTnI<5 ng/L and 1-hour change<2 ng/L), and the 0/1-hour algorithm recommended in the European Society of Cardiology guideline combining LOD and 1-hour algorithm. RESULTS: Among 2828 enrolled patients, acute myocardial infarction was the final diagnosis in 451 (16%) patients. The LOD approach ruled out 453 patients (16%) with a sensitivity of 100% (95% confidence interval [CI], 99.2%-100%), the single cutoff 1516 patients (54%) with a sensitivity of 97.1% (95% CI, 95.1%-98.3%), the 1-hour algorithm 1459 patients (52%) with a sensitivity of 98.4% (95% CI, 96.8%-99.2%), and the 0/1-hour algorithm 1463 patients (52%) with a sensitivity of 98.4% (95% CI, 96.8%-99.2%). Predefined subgroup analysis in early presenters (<= 2 hours) revealed significantly lower sensitivity (94.2%, interaction P=0.03) of the single cutoff, but not the other strategies. Two-year survival was 100% with LOD and 98.1% with the other strategies (P<0.01 for LOD versus each of the other strategies). CONCLUSIONS: All 4 rule-out strategies balance effectiveness and safety equally well. The single cutoff should not be applied in early presenters, whereas the 3 other strategies seem to perform well in this challenging subgroup.
ER  -

BOEDDINGHAUS, J.; T. NESTELBERGER; R. TWERENBOLD; K. WILDI; P. BADERTSCHER; J. CUPA; T. BURGE; P. MACHLER; S. CORBIERE; K. GRIMM; M.R. GIMENEZ; C. PUELACHER; S. SHRESTHA; D.F. WIDMER; J. FUHRMANN; P. HILLINGER; Z. SABTI; U. HONEGGER; N. SCHAERLI; N. KOZHUHAROV; K. RENTSCH; O. MIRO; B. LOPEZ; F.J. MARTIN-SANCHEZ; E. RODRIGUEZ-ADRADA; B. MORAWIEC; D. KAWECKI; Eva GANOVSKÁ; Jiří PAŘENICA; J. LOHRMANN; W. KLOOS; A. BUSER; N. GEIGY; D.I. KELLER; S. OSSWALD; T. REICHLIN a C. MUELLER. Direct Comparison of 4 Very Early Rule-Out Strategies for Acute Myocardial Infarction Using High-Sensitivity Cardiac Troponin I. \textit{Circulation}. Philadelphia: Lippincott Williams Wilkins, 2017, roč.~135, č.~17, s.~''1597''-''+'', 31 s. ISSN~0009-7322. Dostupné z: https://doi.org/10.1161/CIRCULATIONAHA.116.025661.

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