Comparison of fourteen rule-out strategies for acute myocardial
infarction

J 2019

Comparison of fourteen rule-out strategies for acute myocardial infarction

WILDI, Karin, Jasper BOEDDINGHAUS, Thomas NESTELBERGER, Raphael TWERENBOLD, Patrick BADERTSCHER et. al.

Basic information

Original name

Comparison of fourteen rule-out strategies for acute myocardial infarction

Authors

WILDI, Karin (756 Switzerland), Jasper BOEDDINGHAUS (756 Switzerland), Thomas NESTELBERGER (756 Switzerland), Raphael TWERENBOLD (756 Switzerland), Patrick BADERTSCHER (756 Switzerland), Desiree WUSSLER (756 Switzerland), Maria Rubini GIMENEZ (756 Switzerland), Christian PUELACHER (756 Switzerland), Jeanne du Fay de LAVALLAZ (756 Switzerland), Sebastian DIETSCHE (756 Switzerland), Joan WALTER (756 Switzerland), Nikola KOZHUHAROV (756 Switzerland), Beata MORAWIEC (380 Italy), Oscar MIRO (380 Italy), Javier F. MARTIN-SANCHEZ (380 Italy), Sinthuri SUBRAMANIAM (380 Italy), Nicolas GEIGY (756 Switzerland), Dagmar I. KELLER (756 Switzerland), Tobias REICHLIN (756 Switzerland), Christian MUELLER (756 Switzerland, guarantor), Deborah MUELLER (756 Switzerland), Lorraine SAZGARY (756 Switzerland), Stella MARBOT (756 Switzerland), Zaid SABTI (756 Switzerland), Dayana FLORES (756 Switzerland), Kathrin MEISSNER (756 Switzerland), Caroline KULANGARA (756 Switzerland), Michael FREESE (756 Switzerland), Stefan OSSWALD (756 Switzerland), Claudia STELZIG (756 Switzerland), Roland BINGISSER (756 Switzerland), Beatriz LOPEZ (724 Spain), María M. AGUERO (724 Spain), Ewa NOWALANY-KOZIELSKA (616 Poland), Damian KAWECKI (616 Poland), Jiří PAŘENICA (203 Czech Republic, belonging to the institution), Eva GANOVSKÁ (703 Slovakia, belonging to the institution), Jens LOHRMANN (756 Switzerland), Andreas BUSER (756 Switzerland), Dayana FLORES (756 Switzerland), Karin GRIMM (756 Switzerland), Beate HARTMANN (756 Switzerland), Piotr MUZYK (616 Poland), Katharina RENTSCH (756 Switzerland) and Arnold von ECKARDSTEIN (756 Switzerland)

Edition

International Journal of Cardiology, Clare, Elsevier Ireland Ltd. 2019, 0167-5273

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 3.229

RIV identification code

RIV/00216224:14110/19:00109666

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.ijcard.2018.11.140

UT WoS

000461330100007

Keywords in English

Acute myocardial infarction; Diagnosis; Rule-out; High-sensitivity cardiac troponin T and I; Rule-out algorithm; Efficacy

Abstract

V originále

Background: The clinical availability of high-sensitivity cardiac troponin (hs-cTn) has enabled the development of several innovative strategies for the rapid rule-out of acute myocardial infarction (AMI). Due to the lack of direct comparisons, selection of the best strategy for clinical practice is challenging. Methods: In a prospective international multicenter diagnostic study enrolling 3696 patients presenting with suspected AMI to the emergency department, we compared the safety and efficacy of 14 different hs-cTn-based strategies: hs-cTn concentrations below the limit of detection (LoD), dual-marker combining hs-cTn with copeptin, ESC 0 h/1 h-algorithm, 0 h/2 h-algorithm, 2 h-ADP-algorithm, NICE-algorithm, and ESC 0 h/3 h-algorithm, each using either hs-cTnT or hs-cTnI. The final diagnosis of AMI was adjudicated by two independent cardiologists using all available clinical information including cardiac imaging and serial hs-cTn concentrations. Results: AMI was the final diagnosis in 16% of patients. Using hs-cTnT, safety quantified by the negative predictive value (NPV) and sensitivity was very high (99.8-100% and 99.5-100%) and comparable for all strategies, except the dual-marker approach (NPV 98.7%, sensitivity 96.7%). Similarly, using hs-cTnI, safety quantified by the NPV and sensitivity was very high (99.7-100% and 98.9-100%) and comparable for all strategies, except the dual-marker approach (NPV 96.9%, sensitivity 90.4%) and the NICE-algorithm (NPV 99.1%, sensitivity 94.7%). Efficacy, quantified by the percentage of patients eligible for rule-out, differed markedly, and was lowest for LoD-algorithm (15.7-26.8%). Conclusion: All rapid rule-out algorithms, except the dual-marker strategy and the NICE-algorithm using hs-cTnI, favorably combine safety and efficacy, and can be considered for routine clinical practice. Clinical trial registration: NCT00470587, http://clinicaltrials.gov/show/NCT00470587. (c) 2018 Elsevier B.V. All rights reserved.

Citovat

WILDI, Karin, Jasper BOEDDINGHAUS, Thomas NESTELBERGER, Raphael TWERENBOLD, Patrick BADERTSCHER, Desiree WUSSLER, Maria Rubini GIMENEZ, Christian PUELACHER, Jeanne du Fay de LAVALLAZ, Sebastian DIETSCHE, Joan WALTER, Nikola KOZHUHAROV, Beata MORAWIEC, Oscar MIRO, Javier F. MARTIN-SANCHEZ, Sinthuri SUBRAMANIAM, Nicolas GEIGY, Dagmar I. KELLER, Tobias REICHLIN, Christian MUELLER, Deborah MUELLER, Lorraine SAZGARY, Stella MARBOT, Zaid SABTI, Dayana FLORES, Kathrin MEISSNER, Caroline KULANGARA, Michael FREESE, Stefan OSSWALD, Claudia STELZIG, Roland BINGISSER, Beatriz LOPEZ, María M. AGUERO, Ewa NOWALANY-KOZIELSKA, Damian KAWECKI, Jiří PAŘENICA, Eva GANOVSKÁ, Jens LOHRMANN, Andreas BUSER, Dayana FLORES, Karin GRIMM, Beate HARTMANN, Piotr MUZYK, Katharina RENTSCH and Arnold von ECKARDSTEIN. Comparison of fourteen rule-out strategies for acute myocardial infarction. International Journal of Cardiology. Clare: Elsevier Ireland Ltd., 2019, vol. 283, MAY 15 2019, p. 41-47. ISSN 0167-5273. Available from: https://dx.doi.org/10.1016/j.ijcard.2018.11.140.

@article{1531376,
   author = {Wildi, Karin and Boeddinghaus, Jasper and Nestelberger, Thomas and Twerenbold, Raphael and Badertscher, Patrick and Wussler, Desiree and Gimenez, Maria Rubini and Puelacher, Christian and Lavallaz, Jeanne du Fay de and Dietsche, Sebastian and Walter, Joan and Kozhuharov, Nikola and Morawiec, Beata and Miro, Oscar and MartinandSanchez, Javier F. and Subramaniam, Sinthuri and Geigy, Nicolas and Keller, Dagmar I. and Reichlin, Tobias and Mueller, Christian and Mueller, Deborah and Sazgary, Lorraine and Marbot, Stella and Sabti, Zaid and Flores, Dayana and Meissner, Kathrin and Kulangara, Caroline and Freese, Michael and Osswald, Stefan and Stelzig, Claudia and Bingisser, Roland and Lopez, Beatriz and Aguero, María M. and NowalanyandKozielska, Ewa and Kawecki, Damian and Pařenica, Jiří and Ganovská, Eva and Lohrmann, Jens and Buser, Andreas and Flores, Dayana and Grimm, Karin and Hartmann, Beate and Muzyk, Piotr and Rentsch, Katharina and Eckardstein, Arnold von},
   article_location = {Clare},
   article_number = {MAY 15 2019},
   doi = {http://dx.doi.org/10.1016/j.ijcard.2018.11.140},
   keywords = {Acute myocardial infarction; Diagnosis; Rule-out; High-sensitivity cardiac troponin T and I; Rule-out algorithm; Efficacy},
   language = {eng},
   issn = {0167-5273},
   journal = {International Journal of Cardiology},
   title = {Comparison of fourteen rule-out strategies for acute myocardial infarction},
   url = {http://dx.doi.org/10.1016/j.ijcard.2018.11.140},
   volume = {283},
   year = {2019}
}

TY  - JOUR
ID  - 1531376
AU  - Wildi, Karin - Boeddinghaus, Jasper - Nestelberger, Thomas - Twerenbold, Raphael - Badertscher, Patrick - Wussler, Desiree - Gimenez, Maria Rubini - Puelacher, Christian - Lavallaz, Jeanne du Fay de - Dietsche, Sebastian - Walter, Joan - Kozhuharov, Nikola - Morawiec, Beata - Miro, Oscar - Martin-Sanchez, Javier F. - Subramaniam, Sinthuri - Geigy, Nicolas - Keller, Dagmar I. - Reichlin, Tobias - Mueller, Christian - Mueller, Deborah - Sazgary, Lorraine - Marbot, Stella - Sabti, Zaid - Flores, Dayana - Meissner, Kathrin - Kulangara, Caroline - Freese, Michael - Osswald, Stefan - Stelzig, Claudia - Bingisser, Roland - Lopez, Beatriz - Aguero, María M. - Nowalany-Kozielska, Ewa - Kawecki, Damian - Pařenica, Jiří - Ganovská, Eva - Lohrmann, Jens - Buser, Andreas - Flores, Dayana - Grimm, Karin - Hartmann, Beate - Muzyk, Piotr - Rentsch, Katharina - Eckardstein, Arnold von
PY  - 2019
TI  - Comparison of fourteen rule-out strategies for acute myocardial infarction
JF  - International Journal of Cardiology
VL  - 283
IS  - MAY 15 2019
SP  - 41-47
EP  - 41-47
PB  - Elsevier Ireland Ltd.
SN  - 01675273
KW  - Acute myocardial infarction
KW  - Diagnosis
KW  - Rule-out
KW  - High-sensitivity cardiac troponin T and I
KW  - Rule-out algorithm
KW  - Efficacy
UR  - http://dx.doi.org/10.1016/j.ijcard.2018.11.140
L2  - http://dx.doi.org/10.1016/j.ijcard.2018.11.140
N2  - Background: The clinical availability of high-sensitivity cardiac troponin (hs-cTn) has enabled the development of several innovative strategies for the rapid rule-out of acute myocardial infarction (AMI). Due to the lack of direct comparisons, selection of the best strategy for clinical practice is challenging. Methods: In a prospective international multicenter diagnostic study enrolling 3696 patients presenting with suspected AMI to the emergency department, we compared the safety and efficacy of 14 different hs-cTn-based strategies: hs-cTn concentrations below the limit of detection (LoD), dual-marker combining hs-cTn with copeptin, ESC 0 h/1 h-algorithm, 0 h/2 h-algorithm, 2 h-ADP-algorithm, NICE-algorithm, and ESC 0 h/3 h-algorithm, each using either hs-cTnT or hs-cTnI. The final diagnosis of AMI was adjudicated by two independent cardiologists using all available clinical information including cardiac imaging and serial hs-cTn concentrations. Results: AMI was the final diagnosis in 16% of patients. Using hs-cTnT, safety quantified by the negative predictive value (NPV) and sensitivity was very high (99.8-100% and 99.5-100%) and comparable for all strategies, except the dual-marker approach (NPV 98.7%, sensitivity 96.7%). Similarly, using hs-cTnI, safety quantified by the NPV and sensitivity was very high (99.7-100% and 98.9-100%) and comparable for all strategies, except the dual-marker approach (NPV 96.9%, sensitivity 90.4%) and the NICE-algorithm (NPV 99.1%, sensitivity 94.7%). Efficacy, quantified by the percentage of patients eligible for rule-out, differed markedly, and was lowest for LoD-algorithm (15.7-26.8%). Conclusion: All rapid rule-out algorithms, except the dual-marker strategy and the NICE-algorithm using hs-cTnI, favorably combine safety and efficacy, and can be considered for routine clinical practice. Clinical trial registration: NCT00470587, http://clinicaltrials.gov/show/NCT00470587. (c) 2018 Elsevier B.V. All rights reserved.
ER  -

WILDI, Karin, Jasper BOEDDINGHAUS, Thomas NESTELBERGER, Raphael TWERENBOLD, Patrick BADERTSCHER, Desiree WUSSLER, Maria Rubini GIMENEZ, Christian PUELACHER, Jeanne du Fay de LAVALLAZ, Sebastian DIETSCHE, Joan WALTER, Nikola KOZHUHAROV, Beata MORAWIEC, Oscar MIRO, Javier F. MARTIN-SANCHEZ, Sinthuri SUBRAMANIAM, Nicolas GEIGY, Dagmar I. KELLER, Tobias REICHLIN, Christian MUELLER, Deborah MUELLER, Lorraine SAZGARY, Stella MARBOT, Zaid SABTI, Dayana FLORES, Kathrin MEISSNER, Caroline KULANGARA, Michael FREESE, Stefan OSSWALD, Claudia STELZIG, Roland BINGISSER, Beatriz LOPEZ, María M. AGUERO, Ewa NOWALANY-KOZIELSKA, Damian KAWECKI, Jiří PAŘENICA, Eva GANOVSKÁ, Jens LOHRMANN, Andreas BUSER, Dayana FLORES, Karin GRIMM, Beate HARTMANN, Piotr MUZYK, Katharina RENTSCH and Arnold von ECKARDSTEIN. Comparison of fourteen rule-out strategies for acute myocardial infarction. \textit{International Journal of Cardiology}. Clare: Elsevier Ireland Ltd., 2019, vol.~283, MAY 15 2019, p.~41-47. ISSN~0167-5273. Available from: https://dx.doi.org/10.1016/j.ijcard.2018.11.140.

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