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, 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, roč. 135, č. 17, s. "1597"-"+", 31 s. ISSN 0009-7322. doi:10.1161/CIRCULATIONAHA.116.025661. 2017.

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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  -

Základní údaje
Originální název	Direct Comparison of 4 Very Early Rule-Out Strategies for Acute Myocardial Infarction Using High-Sensitivity Cardiac Troponin I
Autoři	BOEDDINGHAUS, J. (380 Itálie), T. NESTELBERGER (380 Itálie), R. TWERENBOLD (380 Itálie), K. WILDI (380 Itálie), P. BADERTSCHER (380 Itálie), J. CUPA (380 Itálie), T. BURGE (756 Švýcarsko), P. MACHLER (756 Švýcarsko), S. CORBIERE (380 Itálie), K. GRIMM (380 Itálie), M.R. GIMENEZ (380 Itálie), C. PUELACHER (380 Itálie), S. SHRESTHA (380 Itálie), D.F. WIDMER (380 Itálie), J. FUHRMANN (756 Švýcarsko), P. HILLINGER (380 Itálie), Z. SABTI (380 Itálie), U. HONEGGER (380 Itálie), N. SCHAERLI (380 Itálie), N. KOZHUHAROV (380 Itálie), K. RENTSCH (756 Švýcarsko), O. MIRO (724 Španělsko), B. LOPEZ (724 Španělsko), F.J. MARTIN-SANCHEZ (724 Španělsko), E. RODRIGUEZ-ADRADA (724 Španělsko), B. MORAWIEC (616 Polsko), D. KAWECKI (616 Polsko), Eva GANOVSKÁ (703 Slovensko, domácí), Jiří PAŘENICA (203 Česká republika, garant, domácí), J. LOHRMANN (756 Švýcarsko), W. KLOOS (756 Švýcarsko), A. BUSER (756 Švýcarsko), N. GEIGY (756 Švýcarsko), D.I. KELLER (756 Švýcarsko), S. OSSWALD (756 Švýcarsko), T. REICHLIN (756 Švýcarsko) a C. MUELLER (756 Švýcarsko).
Vydání	Circulation, Philadelphia, Lippincott Williams Wilkins, 2017, 0009-7322.

Další údaje
Originální 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
Kód RIV	RIV/00216224:14110/17:00097703
Organizační jednotka	Lékařská fakulta
Doi	http://dx.doi.org/10.1161/CIRCULATIONAHA.116.025661
UT WoS	000400006400010
Klíčová slova anglicky	diagnosis; myocardial infarction; rule-out strategies
Štítky	EL OK
Příznaky	Mezinárodní význam, Recenzováno
Změnil	Změnila: Soňa Böhmová, učo 232884. Změněno: 21. 3. 2018 16:03.

Anotace

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.

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