0/1-Hour Triage Algorithm for Myocardial Infarction in Patients
With Renal Dysfunction

J 2018

0/1-Hour Triage Algorithm for Myocardial Infarction in Patients With Renal Dysfunction

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

Basic information

Original name

0/1-Hour Triage Algorithm for Myocardial Infarction in Patients With Renal Dysfunction

Authors

TWERENBOLD, R. (756 Switzerland); P. BADERTSCHER (756 Switzerland); J. BOEDDINGHAUS (756 Switzerland); T. NESTELBERGER (756 Switzerland); K. WILDI (756 Switzerland); C. PUELACHER (756 Switzerland); Z. SABTI (756 Switzerland); M.R. GIMENEZ (756 Switzerland); S. TSCHIRKY (756 Switzerland); J.D. de LAVALLAZ (756 Switzerland); N. KOZHUHAROV (756 Switzerland); L. SAZGARY (756 Switzerland); D. MUELLER (756 Switzerland); T. BREIDTHARDT (756 Switzerland); I. STREBEL (756 Switzerland); D.F. WIDMER (756 Switzerland); S. SHRESTHA (756 Switzerland); O. MIRO (724 Spain); F.J. MARTIN-SANCHEZ (724 Spain); B. MORAWIEC (616 Poland); Jiří PAŘENICA (203 Czech Republic, belonging to the institution); N. GEIGY (756 Switzerland); D.I. KELLER (756 Switzerland); K. RENTSCH (756 Switzerland); A. von ECKARDSTEIN (756 Switzerland); S. OSSWALD (756 Switzerland); T. REICHLIN (756 Switzerland) and C. MUELLER (756 Switzerland, guarantor)

Edition

Circulation, Philadelphia, Lippincott Williams Wilkins, 2018, 0009-7322

Other information

Language

English

Type of outcome

Article in a journal

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United States of America

Confidentiality degree

is not subject to a state or trade secret

Impact factor

Impact factor: 23.054

RIV identification code

RIV/00216224:14110/18:00103658

Organization unit

Faculty of Medicine

DOI

https://doi.org/10.1161/CIRCULATIONAHA.117.028901

UT WoS

000423565200005

EID Scopus

2-s2.0-85048400833

Keywords in English

0/1-hour algorithm; chronic kidney disease; diagnosis of acute myocardial infarction; high-sensitivity cardiac troponin; renal dysfunction

Abstract

In the original language

Background: The European Society of Cardiology recommends a 0/1-hour algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction using high-sensitivity cardiac troponin (hs-cTn) concentrations irrespective of renal function. Because patients with renal dysfunction (RD) frequently present with increased hs-cTn concentrations even in the absence of non-ST-segment elevation myocardial infarction, concern has been raised regarding the performance of the 0/1-hour algorithm in RD. Methods: In a prospective multicenter diagnostic study enrolling unselected patients presenting with suspected non-ST-segment elevation myocardial infarction to the emergency department, we assessed the diagnostic performance of the European Society of Cardiology 0/1-hour algorithm using hs-cTnT and hs-cTnI in patients with RD, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2), and compared it to patients with normal renal function. The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including cardiac imaging. Safety was quantified as sensitivity in the rule-out zone, accuracy as the specificity in the rule-in zone, and efficacy as the proportion of the overall cohort assigned to either rule-out or rule-in based on the 0- and 1-hour sample. Results: Among 3254 patients, RD was present in 487 patients (15%). The prevalence of non-ST-segment elevation myocardial infarction was substantially higher in patients with RD compared with patients with normal renal function (31% versus 13%, P<0.001). Using hs-cTnT, patients with RD had comparable sensitivity of rule-out (100.0% [95% confidence interval {CI}, 97.6-100.0] versus 99.2% [95% CI, 97.6-99.8]; P=0.559), lower specificity of rule-in (88.7% [95% CI, 84.8-91.9] versus 96.5% [95% CI, 95.7-97.2]; P<0.001), and lower overall efficacy (51% versus 81%, P<0.001), mainly driven by a much lower percentage of patients eligible for rule-out (18% versus 68%, P<0.001) compared with patients with normal renal function. Using hs-cTnI, patients with RD had comparable sensitivity of rule-out (98.6% [95% CI, 95.0-99.8] versus 98.5% [95% CI, 96.5-99.5]; P=1.0), lower specificity of rule-in (84.4% [95% CI, 79.9-88.3] versus 91.7% [95% CI, 90.5-92.9]; P<0.001), and lower overall efficacy (54% versus 76%, P<0.001; proportion ruled out, 18% versus 58%, P<0.001) compared with patients with normal renal function. Conclusions: In patients with RD, the safety of the European Society of Cardiology 0/1-hour algorithm is high, but specificity of rule-in and overall efficacy are decreased. Modifications of the rule-in and rule-out thresholds did not improve the safety or overall efficacy of the 0/1-hour algorithm. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00470587.

Cite

TWERENBOLD, R.; P. BADERTSCHER; J. BOEDDINGHAUS; T. NESTELBERGER; K. WILDI; C. PUELACHER; Z. SABTI; M.R. GIMENEZ; S. TSCHIRKY; J.D. de LAVALLAZ; N. KOZHUHAROV; L. SAZGARY; D. MUELLER; T. BREIDTHARDT; I. STREBEL; D.F. WIDMER; S. SHRESTHA; O. MIRO; F.J. MARTIN-SANCHEZ; B. MORAWIEC; Jiří PAŘENICA; N. GEIGY; D.I. KELLER; K. RENTSCH; A. von ECKARDSTEIN; S. OSSWALD; T. REICHLIN and C. MUELLER. 0/1-Hour Triage Algorithm for Myocardial Infarction in Patients With Renal Dysfunction. Circulation. Philadelphia: Lippincott Williams Wilkins, 2018, vol. 137, No 5, p. 436-451. ISSN 0009-7322. Available from: https://doi.org/10.1161/CIRCULATIONAHA.117.028901.

@article{1435290,
   author = {Twerenbold, R. and Badertscher, P. and Boeddinghaus, J. and Nestelberger, T. and Wildi, K. and Puelacher, C. and Sabti, Z. and Gimenez, M.R. and Tschirky, S. and Lavallaz, J.D. de and Kozhuharov, N. and Sazgary, L. and Mueller, D. and Breidthardt, T. and Strebel, I. and Widmer, D.F. and Shrestha, S. and Miro, O. and MartinandSanchez, F.J. and Morawiec, B. and Pařenica, Jiří and Geigy, N. and Keller, D.I. and Rentsch, K. and Eckardstein, A. von and Osswald, S. and Reichlin, T. and Mueller, C.},
   article_location = {Philadelphia},
   article_number = {5},
   doi = {https://doi.org/10.1161/CIRCULATIONAHA.117.028901},
   keywords = {0/1-hour algorithm; chronic kidney disease; diagnosis of acute myocardial infarction; high-sensitivity cardiac troponin; renal dysfunction},
   language = {eng},
   issn = {0009-7322},
   journal = {Circulation},
   title = {0/1-Hour Triage Algorithm for Myocardial Infarction in Patients With Renal Dysfunction},
   volume = {137},
   year = {2018}
}

TY  - JOUR
ID  - 1435290
AU  - Twerenbold, R. - Badertscher, P. - Boeddinghaus, J. - Nestelberger, T. - Wildi, K. - Puelacher, C. - Sabti, Z. - Gimenez, M.R. - Tschirky, S. - Lavallaz, J.D. de - Kozhuharov, N. - Sazgary, L. - Mueller, D. - Breidthardt, T. - Strebel, I. - Widmer, D.F. - Shrestha, S. - Miro, O. - Martin-Sanchez, F.J. - Morawiec, B. - Pařenica, Jiří - Geigy, N. - Keller, D.I. - Rentsch, K. - Eckardstein, A. von - Osswald, S. - Reichlin, T. - Mueller, C.
PY  - 2018
TI  - 0/1-Hour Triage Algorithm for Myocardial Infarction in Patients With Renal Dysfunction
JF  - Circulation
VL  - 137
IS  - 5
SP  - 436-451
EP  - 436-451
PB  - Lippincott Williams Wilkins
SN  - 00097322
KW  - 0/1-hour algorithm
KW  - chronic kidney disease
KW  - diagnosis of acute myocardial infarction
KW  - high-sensitivity cardiac troponin
KW  - renal dysfunction
N2  - Background: The European Society of Cardiology recommends a 0/1-hour algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction using high-sensitivity cardiac troponin (hs-cTn) concentrations irrespective of renal function. Because patients with renal dysfunction (RD) frequently present with increased hs-cTn concentrations even in the absence of non-ST-segment elevation myocardial infarction, concern has been raised regarding the performance of the 0/1-hour algorithm in RD. Methods: In a prospective multicenter diagnostic study enrolling unselected patients presenting with suspected non-ST-segment elevation myocardial infarction to the emergency department, we assessed the diagnostic performance of the European Society of Cardiology 0/1-hour algorithm using hs-cTnT and hs-cTnI in patients with RD, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2), and compared it to patients with normal renal function. The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including cardiac imaging. Safety was quantified as sensitivity in the rule-out zone, accuracy as the specificity in the rule-in zone, and efficacy as the proportion of the overall cohort assigned to either rule-out or rule-in based on the 0- and 1-hour sample. Results: Among 3254 patients, RD was present in 487 patients (15%). The prevalence of non-ST-segment elevation myocardial infarction was substantially higher in patients with RD compared with patients with normal renal function (31% versus 13%, P<0.001). Using hs-cTnT, patients with RD had comparable sensitivity of rule-out (100.0% [95% confidence interval {CI}, 97.6-100.0] versus 99.2% [95% CI, 97.6-99.8]; P=0.559), lower specificity of rule-in (88.7% [95% CI, 84.8-91.9] versus 96.5% [95% CI, 95.7-97.2]; P<0.001), and lower overall efficacy (51% versus 81%, P<0.001), mainly driven by a much lower percentage of patients eligible for rule-out (18% versus 68%, P<0.001) compared with patients with normal renal function. Using hs-cTnI, patients with RD had comparable sensitivity of rule-out (98.6% [95% CI, 95.0-99.8] versus 98.5% [95% CI, 96.5-99.5]; P=1.0), lower specificity of rule-in (84.4% [95% CI, 79.9-88.3] versus 91.7% [95% CI, 90.5-92.9]; P<0.001), and lower overall efficacy (54% versus 76%, P<0.001; proportion ruled out, 18% versus 58%, P<0.001) compared with patients with normal renal function. Conclusions: In patients with RD, the safety of the European Society of Cardiology 0/1-hour algorithm is high, but specificity of rule-in and overall efficacy are decreased. Modifications of the rule-in and rule-out thresholds did not improve the safety or overall efficacy of the 0/1-hour algorithm. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00470587.
ER  -

TWERENBOLD, R.; P. BADERTSCHER; J. BOEDDINGHAUS; T. NESTELBERGER; K. WILDI; C. PUELACHER; Z. SABTI; M.R. GIMENEZ; S. TSCHIRKY; J.D. de LAVALLAZ; N. KOZHUHAROV; L. SAZGARY; D. MUELLER; T. BREIDTHARDT; I. STREBEL; D.F. WIDMER; S. SHRESTHA; O. MIRO; F.J. MARTIN-SANCHEZ; B. MORAWIEC; Jiří PAŘENICA; N. GEIGY; D.I. KELLER; K. RENTSCH; A. von ECKARDSTEIN; S. OSSWALD; T. REICHLIN and C. MUELLER. 0/1-Hour Triage Algorithm for Myocardial Infarction in Patients With Renal Dysfunction. \textit{Circulation}. Philadelphia: Lippincott Williams Wilkins, 2018, vol.~137, No~5, p.~436-451. ISSN~0009-7322. Available from: https://doi.org/10.1161/CIRCULATIONAHA.117.028901.

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