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@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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