Impact of age on the performance of the ESC 0/1h-algorithms for
early diagnosis of myocardial infarction

J 2018

Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction

BOEDDINGHAUS, J., T. NESTELBERGER, R. TWERENBOLD, J.T. NEUMANN, B. LINDAHL et. al.

Basic information

Original name

Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction

Authors

BOEDDINGHAUS, J. (756 Switzerland), T. NESTELBERGER (756 Switzerland), R. TWERENBOLD (756 Switzerland), J.T. NEUMANN (276 Germany), B. LINDAHL (752 Sweden), E. GIANNITSIS (276 Germany), N.A. SORENSEN (276 Germany), P. BADERTSCHER (756 Switzerland), J.E. JANN (756 Switzerland), D. WUSSLER (756 Switzerland), C. PUELACHER (756 Switzerland), M.R. GIMENEZ (756 Switzerland), K. WILDI (756 Switzerland), I. STREBEL (756 Switzerland), J.D. de LAVALLAZ (756 Switzerland), F. SELMAN (756 Switzerland), Z. SABTI (756 Switzerland), N. KOZHUHAROV (756 Switzerland), E. POTLUKOVA (756 Switzerland), K. RENTSCH (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), 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), D. WESTERMANN (276 Germany), S. BLANKENBERG (276 Germany) and C. MUELLER (756 Switzerland, guarantor)

Edition

European heart journal, Oxford, Oxford University Press, 2018, 0195-668X

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

Impact factor

Impact factor: 24.889

RIV identification code

RIV/00216224:14110/18:00104899

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1093/eurheartj/ehy514

UT WoS

000450054600010

Keywords in English

Age; High-sensitivity cardiac troponin; Guidelines; 0/1h-Algorithm; Diagnosis of AMI

Abstract

V originále

Aims We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1h-algorithms and to derive and externally validate alternative cut-offs specific to older patients. Methods and results We prospectively enrolled patients presenting to the emergency department (ED) with symptoms suggestive of and results acute myocardial infarction in three large diagnostic studies. Final diagnoses were adjudicated by two independent cardiologists. High-sensitivity cardiac troponin (hs-cTn) T and I concentrations were measured at presentation and after 1 h. Patients were stratified according to age [<55 years (young), >= 55 to <70 years (middle-age), >= 70 years (old)]. Rule-out safety of the ESC hs-cTnT 0/1h-algorithm was very high in all age-strata: sensitivity 100% [95% confidence interval (95% CI) 94.9-100] in young, 99.3% (95% CI 96.0-99.9) in middle-age, and 99.3% (95% CI 97.599.8) in old patients. Accuracy of rule-in decreased with age: specificity 97.0% (95% CI 95.8-97.9) in young, 96.1% (95% CI 94.5-97.2) in middle-age, and 92.7% (95% CI 90.7-94.3) in older patients. Triage efficacy decreased with increasing age (young 93%, middle-age 80%, old 55%, P <0.001). Similar results were found for the ESC hs-cTnT 0/1h-algorithm. Alternative, slightly higher cut-off concentrations optimized for older patients maintained very high safety of rule-out, increased specificity of rule-in (P< 0.01), reduced overall efficacy for hs-cTnT (P <0.01), while maintaining efficacy for hs-cTnl. Findings were confirmed in two validation cohorts (n = 2767). Conclusion While safety of the ESC 0/1h-algorithms remained very high, increasing age significantly reduced overall efficacy and the accuracy of rule-in. Alternative slightly higher cut-off concentrations may be considered for older patients, particularly if using hs-cTnl.

Citovat

BOEDDINGHAUS, J., T. NESTELBERGER, R. TWERENBOLD, J.T. NEUMANN, B. LINDAHL, E. GIANNITSIS, N.A. SORENSEN, P. BADERTSCHER, J.E. JANN, D. WUSSLER, C. PUELACHER, M.R. GIMENEZ, K. WILDI, I. STREBEL, J.D. de LAVALLAZ, F. SELMAN, Z. SABTI, N. KOZHUHAROV, E. POTLUKOVA, K. RENTSCH, O. MIRO, F.J. MARTIN-SANCHEZ, B. MORAWIEC, Jiří PAŘENICA, J. LOHRMANN, W. KLOOS, A. BUSER, N. GEIGY, D.I. KELLER, S. OSSWALD, T. REICHLIN, D. WESTERMANN, S. BLANKENBERG and C. MUELLER. Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction. European heart journal. Oxford: Oxford University Press, 2018, vol. 39, No 42, p. 3780-3794. ISSN 0195-668X. Available from: https://dx.doi.org/10.1093/eurheartj/ehy514.

@article{1477961,
   author = {Boeddinghaus, J. and Nestelberger, T. and Twerenbold, R. and Neumann, J.T. and Lindahl, B. and Giannitsis, E. and Sorensen, N.A. and Badertscher, P. and Jann, J.E. and Wussler, D. and Puelacher, C. and Gimenez, M.R. and Wildi, K. and Strebel, I. and Lavallaz, J.D. de and Selman, F. and Sabti, Z. and Kozhuharov, N. and Potlukova, E. and Rentsch, K. and Miro, O. and MartinandSanchez, F.J. and Morawiec, B. 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 Westermann, D. and Blankenberg, S. and Mueller, C.},
   article_location = {Oxford},
   article_number = {42},
   doi = {http://dx.doi.org/10.1093/eurheartj/ehy514},
   keywords = {Age; High-sensitivity cardiac troponin; Guidelines; 0/1h-Algorithm; Diagnosis of AMI},
   language = {eng},
   issn = {0195-668X},
   journal = {European heart journal},
   title = {Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction},
   volume = {39},
   year = {2018}
}

TY  - JOUR
ID  - 1477961
AU  - Boeddinghaus, J. - Nestelberger, T. - Twerenbold, R. - Neumann, J.T. - Lindahl, B. - Giannitsis, E. - Sorensen, N.A. - Badertscher, P. - Jann, J.E. - Wussler, D. - Puelacher, C. - Gimenez, M.R. - Wildi, K. - Strebel, I. - Lavallaz, J.D. de - Selman, F. - Sabti, Z. - Kozhuharov, N. - Potlukova, E. - Rentsch, K. - Miro, O. - Martin-Sanchez, F.J. - Morawiec, B. - Pařenica, Jiří - Lohrmann, J. - Kloos, W. - Buser, A. - Geigy, N. - Keller, D.I. - Osswald, S. - Reichlin, T. - Westermann, D. - Blankenberg, S. - Mueller, C.
PY  - 2018
TI  - Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction
JF  - European heart journal
VL  - 39
IS  - 42
SP  - 3780-3794
EP  - 3780-3794
PB  - Oxford University Press
SN  - 0195668X
KW  - Age
KW  - High-sensitivity cardiac troponin
KW  - Guidelines
KW  - 0/1h-Algorithm
KW  - Diagnosis of AMI
N2  - Aims We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1h-algorithms and to derive and externally validate alternative cut-offs specific to older patients. Methods and results We prospectively enrolled patients presenting to the emergency department (ED) with symptoms suggestive of and results acute myocardial infarction in three large diagnostic studies. Final diagnoses were adjudicated by two independent cardiologists. High-sensitivity cardiac troponin (hs-cTn) T and I concentrations were measured at presentation and after 1 h. Patients were stratified according to age [<55 years (young), >= 55 to <70 years (middle-age), >= 70 years (old)]. Rule-out safety of the ESC hs-cTnT 0/1h-algorithm was very high in all age-strata: sensitivity 100% [95% confidence interval (95% CI) 94.9-100] in young, 99.3% (95% CI 96.0-99.9) in middle-age, and 99.3% (95% CI 97.599.8) in old patients. Accuracy of rule-in decreased with age: specificity 97.0% (95% CI 95.8-97.9) in young, 96.1% (95% CI 94.5-97.2) in middle-age, and 92.7% (95% CI 90.7-94.3) in older patients. Triage efficacy decreased with increasing age (young 93%, middle-age 80%, old 55%, P <0.001). Similar results were found for the ESC hs-cTnT 0/1h-algorithm. Alternative, slightly higher cut-off concentrations optimized for older patients maintained very high safety of rule-out, increased specificity of rule-in (P< 0.01), reduced overall efficacy for hs-cTnT (P <0.01), while maintaining efficacy for hs-cTnl. Findings were confirmed in two validation cohorts (n = 2767). Conclusion While safety of the ESC 0/1h-algorithms remained very high, increasing age significantly reduced overall efficacy and the accuracy of rule-in. Alternative slightly higher cut-off concentrations may be considered for older patients, particularly if using hs-cTnl.
ER  -

BOEDDINGHAUS, J., T. NESTELBERGER, R. TWERENBOLD, J.T. NEUMANN, B. LINDAHL, E. GIANNITSIS, N.A. SORENSEN, P. BADERTSCHER, J.E. JANN, D. WUSSLER, C. PUELACHER, M.R. GIMENEZ, K. WILDI, I. STREBEL, J.D. de LAVALLAZ, F. SELMAN, Z. SABTI, N. KOZHUHAROV, E. POTLUKOVA, K. RENTSCH, O. MIRO, F.J. MARTIN-SANCHEZ, B. MORAWIEC, Jiří PAŘENICA, J. LOHRMANN, W. KLOOS, A. BUSER, N. GEIGY, D.I. KELLER, S. OSSWALD, T. REICHLIN, D. WESTERMANN, S. BLANKENBERG and C. MUELLER. Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction. \textit{European heart journal}. Oxford: Oxford University Press, 2018, vol.~39, No~42, p.~3780-3794. ISSN~0195-668X. Available from: https://dx.doi.org/10.1093/eurheartj/ehy514.

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