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.

Basic information

Original name

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

Authors

BOEDDINGHAUS, J. (380 Italy), T. NESTELBERGER (380 Italy), R. TWERENBOLD (380 Italy), K. WILDI (380 Italy), P. BADERTSCHER (380 Italy), J. CUPA (380 Italy), T. BURGE (756 Switzerland), P. MACHLER (756 Switzerland), S. CORBIERE (380 Italy), K. GRIMM (380 Italy), M.R. GIMENEZ (380 Italy), C. PUELACHER (380 Italy), S. SHRESTHA (380 Italy), D.F. WIDMER (380 Italy), J. FUHRMANN (756 Switzerland), P. HILLINGER (380 Italy), Z. SABTI (380 Italy), U. HONEGGER (380 Italy), N. SCHAERLI (380 Italy), N. KOZHUHAROV (380 Italy), K. RENTSCH (756 Switzerland), O. MIRO (724 Spain), B. LOPEZ (724 Spain), F.J. MARTIN-SANCHEZ (724 Spain), E. RODRIGUEZ-ADRADA (724 Spain), B. MORAWIEC (616 Poland), D. KAWECKI (616 Poland), Eva GANOVSKÁ (703 Slovakia, belonging to the institution), Jiří PAŘENICA (203 Czech Republic, guarantor, belonging to the institution), J. LOHRMANN (756 Switzerland), W. KLOOS (756 Switzerland), A. BUSER (756 Switzerland), N. GEIGY (756 Switzerland), D.I. KELLER (756 Switzerland), S. OSSWALD (756 Switzerland), T. REICHLIN (756 Switzerland) and C. MUELLER (756 Switzerland)

Edition

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

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

Impact factor

Impact factor: 18.881

RIV identification code

RIV/00216224:14110/17:00097703

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1161/CIRCULATIONAHA.116.025661

UT WoS

000400006400010

Keywords in English

diagnosis; myocardial infarction; rule-out strategies

Abstract

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 and 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, vol. 135, No 17, p. "1597"-"+", 31 pp. ISSN 0009-7322. Available from: https://dx.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 = {http://dx.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 and 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, vol.~135, No~17, p.~''1597''-''+'', 31 pp. ISSN~0009-7322. Available from: https://dx.doi.org/10.1161/CIRCULATIONAHA.116.025661.

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