Prospective Validation of the 0/1-h Algorithm for Early
Diagnosis of Myocardial Infarction

J 2018

Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction

TWERENBOLD, R., J.T. NEUMANN, N.A. SORENSEN, F. OJEDA, M. KARAKAS et. al.

Basic information

Original name

Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction

Authors

TWERENBOLD, R. (756 Switzerland), J.T. NEUMANN (276 Germany), N.A. SORENSEN (276 Germany), F. OJEDA (276 Germany), M. KARAKAS (276 Germany), J. BOEDDINGHAUS (756 Switzerland), T. NESTELBERGER (756 Switzerland), P. BADERTSCHER (756 Switzerland), M.R. GIMEENEZ (756 Switzerland), C. PUELACHER (756 Switzerland), K. WILDI (756 Switzerland), N. KOZHUHAROV (756 Switzerland), D. BREITENBUECHER (756 Switzerland), E. BISKUP (756 Switzerland), J.D. de LAVALLAZ (756 Switzerland), D. FLORES (756 Switzerland), D. WUSSLER (756 Switzerland), O. MIRO (724 Spain), F.J.M. 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), T. ZELLER (276 Germany), T. REICHLIN (756 Switzerland), S. BLANKENBERG (276 Germany), D. WESTERMANN (276 Germany, guarantor) and C. MUELLER (756 Switzerland)

Edition

Journal of the American College of Cardiology, New York, Elsevier Science INC, 2018, 0735-1097

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: 18.639

RIV identification code

RIV/00216224:14110/18:00104902

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.jacc.2018.05.040

UT WoS

000440157200005

Keywords in English

diagnosis of myocardial infarction; diagnostic algorithms; myocardial infarction; rule-in; rule-out; troponin

Abstract

V originále

BACKGROUND The safety of the European Society of Cardiology (ESC) 0/1-h algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin (hs-cTn) has been questioned. OBJECTIVES This study aimed to validate the diagnostic performance of the 0/1-h algorithm in a large multicenter study. METHODS The authors prospectively enrolled unsetected patients in 6 countries presenting to the emergency department with symptoms suggestive of NSTEMI. Final diagnosis was centrally adjudicated by 2 independent cardiologists. Hs-cTnT and hs-cTnI blood concentrations were measured at presentation and after 1 h. Safety of rule-out was quantified by the negative predictive value (NPV) for NSTEMI, accuracy of rule-in by the positive predictive value (PPV), and overall efficacy by the proportion of patients triaged towards rule-out or rule-in within 1 h. RESULTS Prevalence of NSTEMI was 17%. Among 4,368 patients with serial hs-cTnT measurements available, safety of rule-out (NPV 99.8%, 2,488 of 2,493), accuracy of rule-in (PPV 74.5%, 572 of 768), and overall efficacy were high by assigning three-fourths of patients either to rule-out (57%, 2,493 to 4,368) or rule-in (18%, 768 to 4,368). Similarly, among 3,500 patients with serial hs-cTnI measurements, safety of rule-out (NPV 99.7%, 1,528 of 1,533), accuracy of rule-in (PPV 62.3%, 498 of 800), and overall efficacy were high by assigning more than two-thirds of patients either to rule-out (44%, 1,533 of 3,500) or rule-in (23%, 800 of 3,500). Excellent safety was confirmed in multiple subgroup analyses including patients presenting early h) after chest pain onset. CONCLUSIONS The ESC 0/1-h algorithm using hs-cTnT and hs-cTnI is very safe and effective in triaging patients with suspected NSTEMI. (C) 2018 by the American College of Cardiology Foundation.

Citovat

TWERENBOLD, R., J.T. NEUMANN, N.A. SORENSEN, F. OJEDA, M. KARAKAS, J. BOEDDINGHAUS, T. NESTELBERGER, P. BADERTSCHER, M.R. GIMEENEZ, C. PUELACHER, K. WILDI, N. KOZHUHAROV, D. BREITENBUECHER, E. BISKUP, J.D. de LAVALLAZ, D. FLORES, D. WUSSLER, O. MIRO, F.J.M. SANCHEZ, B. MORAWIEC, Jiří PAŘENICA, N. GEIGY, D.I. KELLER, T. ZELLER, T. REICHLIN, S. BLANKENBERG, D. WESTERMANN and C. MUELLER. Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction. Journal of the American College of Cardiology. New York: Elsevier Science INC, 2018, vol. 72, No 6, p. 620-632. ISSN 0735-1097. Available from: https://dx.doi.org/10.1016/j.jacc.2018.05.040.

@article{1477981,
   author = {Twerenbold, R. and Neumann, J.T. and Sorensen, N.A. and Ojeda, F. and Karakas, M. and Boeddinghaus, J. and Nestelberger, T. and Badertscher, P. and Gimeenez, M.R. and Puelacher, C. and Wildi, K. and Kozhuharov, N. and Breitenbuecher, D. and Biskup, E. and Lavallaz, J.D. de and Flores, D. and Wussler, D. and Miro, O. and Sanchez, F.J.M. and Morawiec, B. and Pařenica, Jiří and Geigy, N. and Keller, D.I. and Zeller, T. and Reichlin, T. and Blankenberg, S. and Westermann, D. and Mueller, C.},
   article_location = {New York},
   article_number = {6},
   doi = {http://dx.doi.org/10.1016/j.jacc.2018.05.040},
   keywords = {diagnosis of myocardial infarction; diagnostic algorithms; myocardial infarction; rule-in; rule-out; troponin},
   language = {eng},
   issn = {0735-1097},
   journal = {Journal of the American College of Cardiology},
   title = {Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction},
   volume = {72},
   year = {2018}
}

TY  - JOUR
ID  - 1477981
AU  - Twerenbold, R. - Neumann, J.T. - Sorensen, N.A. - Ojeda, F. - Karakas, M. - Boeddinghaus, J. - Nestelberger, T. - Badertscher, P. - Gimeenez, M.R. - Puelacher, C. - Wildi, K. - Kozhuharov, N. - Breitenbuecher, D. - Biskup, E. - Lavallaz, J.D. de - Flores, D. - Wussler, D. - Miro, O. - Sanchez, F.J.M. - Morawiec, B. - Pařenica, Jiří - Geigy, N. - Keller, D.I. - Zeller, T. - Reichlin, T. - Blankenberg, S. - Westermann, D. - Mueller, C.
PY  - 2018
TI  - Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction
JF  - Journal of the American College of Cardiology
VL  - 72
IS  - 6
SP  - 620-632
EP  - 620-632
PB  - Elsevier Science INC
SN  - 07351097
KW  - diagnosis of myocardial infarction
KW  - diagnostic algorithms
KW  - myocardial infarction
KW  - rule-in
KW  - rule-out
KW  - troponin
N2  - BACKGROUND The safety of the European Society of Cardiology (ESC) 0/1-h algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin (hs-cTn) has been questioned. OBJECTIVES This study aimed to validate the diagnostic performance of the 0/1-h algorithm in a large multicenter study. METHODS The authors prospectively enrolled unsetected patients in 6 countries presenting to the emergency department with symptoms suggestive of NSTEMI. Final diagnosis was centrally adjudicated by 2 independent cardiologists. Hs-cTnT and hs-cTnI blood concentrations were measured at presentation and after 1 h. Safety of rule-out was quantified by the negative predictive value (NPV) for NSTEMI, accuracy of rule-in by the positive predictive value (PPV), and overall efficacy by the proportion of patients triaged towards rule-out or rule-in within 1 h. RESULTS Prevalence of NSTEMI was 17%. Among 4,368 patients with serial hs-cTnT measurements available, safety of rule-out (NPV 99.8%, 2,488 of 2,493), accuracy of rule-in (PPV 74.5%, 572 of 768), and overall efficacy were high by assigning three-fourths of patients either to rule-out (57%, 2,493 to 4,368) or rule-in (18%, 768 to 4,368). Similarly, among 3,500 patients with serial hs-cTnI measurements, safety of rule-out (NPV 99.7%, 1,528 of 1,533), accuracy of rule-in (PPV 62.3%, 498 of 800), and overall efficacy were high by assigning more than two-thirds of patients either to rule-out (44%, 1,533 of 3,500) or rule-in (23%, 800 of 3,500). Excellent safety was confirmed in multiple subgroup analyses including patients presenting early h) after chest pain onset. CONCLUSIONS The ESC 0/1-h algorithm using hs-cTnT and hs-cTnI is very safe and effective in triaging patients with suspected NSTEMI. (C) 2018 by the American College of Cardiology Foundation.
ER  -

TWERENBOLD, R., J.T. NEUMANN, N.A. SORENSEN, F. OJEDA, M. KARAKAS, J. BOEDDINGHAUS, T. NESTELBERGER, P. BADERTSCHER, M.R. GIMEENEZ, C. PUELACHER, K. WILDI, N. KOZHUHAROV, D. BREITENBUECHER, E. BISKUP, J.D. de LAVALLAZ, D. FLORES, D. WUSSLER, O. MIRO, F.J.M. SANCHEZ, B. MORAWIEC, Jiří PAŘENICA, N. GEIGY, D.I. KELLER, T. ZELLER, T. REICHLIN, S. BLANKENBERG, D. WESTERMANN and C. MUELLER. Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction. \textit{Journal of the American College of Cardiology}. New York: Elsevier Science INC, 2018, vol.~72, No~6, p.~620-632. ISSN~0735-1097. Available from: https://dx.doi.org/10.1016/j.jacc.2018.05.040.

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