Predicting Acute Myocardial Infarction with a Single Blood Draw

J 2019

Predicting Acute Myocardial Infarction with a Single Blood Draw

BOEDDINGHAUS, Jasper, Thomas NESTELBERGER, Patrick BADERTSCHER, Raphael TWERENBOLD, Brigitte FITZE et. al.

Basic information

Original name

Predicting Acute Myocardial Infarction with a Single Blood Draw

Authors

BOEDDINGHAUS, Jasper (756 Switzerland), Thomas NESTELBERGER (756 Switzerland), Patrick BADERTSCHER (756 Switzerland), Raphael TWERENBOLD (756 Switzerland), Brigitte FITZE (756 Switzerland), Desiree WUSSLER (756 Switzerland), Ivo STREBEL (756 Switzerland), Maria Rubini GIMENEZ (756 Switzerland), Karin WILDI (756 Switzerland), Christian PUELACHER (756 Switzerland), Jeanne du Fay DE LAVALLAZ, Loris OEHEN (756 Switzerland), Joan WALTER (756 Switzerland), Oscar MIRO (724 Spain), Javier F. MARTIN-SANCHEZ (724 Spain), Beata MORAWIEC (616 Poland), Eliska POTLUKOVA (756 Switzerland), Dagmar I. KELLER (756 Switzerland), Tobias REICHLIN (756 Switzerland), Christian MUELLER (guarantor), Zaid SABTI (756 Switzerland), Michael FREESE (756 Switzerland), Claudia STELZIG (756 Switzerland), Samyut SHRESTHA (756 Switzerland), Nicolas SCHAERLI (756 Switzerland), Nikola KOZHUHAROV (756 Switzerland), Dayana FLORES (756 Switzerland), Jens LOHRMANN (756 Switzerland), Ewalina BISKUP (756 Switzerland), Wanda KLOOS (756 Switzerland), Stefan OSSWALD (756 Switzerland), Deborah MUELLER (756 Switzerland), Lorraine SAZGARY (756 Switzerland), Beatriz LOPEZ (724 Spain), Esther Rodriguez ADRADA (724 Spain), Damian KAWECKI (616 Poland), Piotr MUZYK (616 Poland), Ewa NOWALANY-KOZIELSKA (616 Poland), Jiří PAŘENICA (203 Czech Republic, belonging to the institution), Eva GANOVSKÁ (703 Slovakia, belonging to the institution), Kathrin MEISSNER (756 Switzerland), Caroline KULANGARA (756 Switzerland), Riham MAHFOUZ (756 Switzerland), Beate HARTMANN (756 Switzerland), Ina FEREL (756 Switzerland), Isabel CAMPODARVE (724 Spain), Katharina RENTSCH (756 Switzerland), Arnold VON ECKARDSTEIN (756 Switzerland), Andreas BUSER (756 Switzerland) and Nicolas GEIGY (756 Switzerland)

Edition

Clinical Chemistry, Washington, USA, Amer. Assoc. Clinical Chemistry, 2019, 0009-9147

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

References:

URL

Impact factor

Impact factor: 7.292

RIV identification code

RIV/00216224:14110/19:00111299

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1373/clinchem.2018.294124

UT WoS

000459957500013

Keywords in English

SENSITIVITY CARDIAC TROPONIN; CHEST-PAIN SYMPTOMS; HOUR RULE-IN; EARLY-DIAGNOSIS; 2-HOUR ALGORITHM; RELATIVE CHANGES; RAPID RULE; VALIDATION; ABSOLUTE; BIOMARKER

Abstract

V originále

BACKGROUND: We desired to determine cardiac troponin (cTn) concentrations necessary to achieve a positive predictive value (PPV) of >75% for acute myocardial infarction (AMI) to justify immediate admission of patients to a monitored unit and, in general, early coronary angiography. METHODS: In a prospective multicenter diagnostic study enrolling patients presenting to the emergency department with symptoms suggestive of AMI, final diagnoses were adjudicated by 2 independent cardiologists based on clinical information including cardiac imaging. cTn concentrations were measured using 5 different sensitive and high-sensitivity cTn (hs-cTn) assays in a blinded fashion at presentation and serially thereafter. The diagnostic end point was PPV for rule-in of AMI of initial cTn concentrations alone and in combination with early changes. RESULTS: Among 3828 patients, 616 (16%) had an AMI. At presentation, 7% to 14% of patients had cTnT/I concentrations associated with a PPV of >= 75%. Adding absolute or relative changes did not significantly further increase the PPV. PPVs increased from 46.5% (95% CI, 43.6-49.4) for hs-cTnT at presentation >14 ng/L to 78.9% (95% CI, 74.7-82.5) for >52 ng/L (P < 0.001), whereas PPVs in higher hs-cTnT strata remained largely unchanged [e.g., 82.4% (95% CI, 77.5-86.7) for >80 ng/L vs 83.9% (95% CI, 76.0-90.1) for >200 ng/L (P = 0.72)]. The addition of early changes in hs-cTnT further increased the PPV up to 60 ng/L, but not for higher concentrations. CONCLUSIONS: Serial sampling does not seem necessary for predicting AMI and concurrent decision-making in about 10% of patients, as it only marginally increases the PPV for AMI and not in a statistically or clinically significant way. (c) 2018 American Association for Clinical Chemistry

Citovat

BOEDDINGHAUS, Jasper, Thomas NESTELBERGER, Patrick BADERTSCHER, Raphael TWERENBOLD, Brigitte FITZE, Desiree WUSSLER, Ivo STREBEL, Maria Rubini GIMENEZ, Karin WILDI, Christian PUELACHER, Jeanne du Fay DE LAVALLAZ, Loris OEHEN, Joan WALTER, Oscar MIRO, Javier F. MARTIN-SANCHEZ, Beata MORAWIEC, Eliska POTLUKOVA, Dagmar I. KELLER, Tobias REICHLIN, Christian MUELLER, Zaid SABTI, Michael FREESE, Claudia STELZIG, Samyut SHRESTHA, Nicolas SCHAERLI, Nikola KOZHUHAROV, Dayana FLORES, Jens LOHRMANN, Ewalina BISKUP, Wanda KLOOS, Stefan OSSWALD, Deborah MUELLER, Lorraine SAZGARY, Beatriz LOPEZ, Esther Rodriguez ADRADA, Damian KAWECKI, Piotr MUZYK, Ewa NOWALANY-KOZIELSKA, Jiří PAŘENICA, Eva GANOVSKÁ, Kathrin MEISSNER, Caroline KULANGARA, Riham MAHFOUZ, Beate HARTMANN, Ina FEREL, Isabel CAMPODARVE, Katharina RENTSCH, Arnold VON ECKARDSTEIN, Andreas BUSER and Nicolas GEIGY. Predicting Acute Myocardial Infarction with a Single Blood Draw. Clinical Chemistry. Washington, USA: Amer. Assoc. Clinical Chemistry, 2019, vol. 65, No 3, p. 437-450. ISSN 0009-9147. Available from: https://dx.doi.org/10.1373/clinchem.2018.294124.

@article{1579477,
   author = {Boeddinghaus, Jasper and Nestelberger, Thomas and Badertscher, Patrick and Twerenbold, Raphael and Fitze, Brigitte and Wussler, Desiree and Strebel, Ivo and Gimenez, Maria Rubini and Wildi, Karin and Puelacher, Christian and de Lavallaz, Jeanne du Fay and Oehen, Loris and Walter, Joan and Miro, Oscar and MartinandSanchez, Javier F. and Morawiec, Beata and Potlukova, Eliska and Keller, Dagmar I. and Reichlin, Tobias and Mueller, Christian and Sabti, Zaid and Freese, Michael and Stelzig, Claudia and Shrestha, Samyut and Schaerli, Nicolas and Kozhuharov, Nikola and Flores, Dayana and Lohrmann, Jens and Biskup, Ewalina and Kloos, Wanda and Osswald, Stefan and Mueller, Deborah and Sazgary, Lorraine and Lopez, Beatriz and Adrada, Esther Rodriguez and Kawecki, Damian and Muzyk, Piotr and NowalanyandKozielska, Ewa and Pařenica, Jiří and Ganovská, Eva and Meissner, Kathrin and Kulangara, Caroline and Mahfouz, Riham and Hartmann, Beate and Ferel, Ina and Campodarve, Isabel and Rentsch, Katharina and von Eckardstein, Arnold and Buser, Andreas and Geigy, Nicolas},
   article_location = {Washington, USA},
   article_number = {3},
   doi = {http://dx.doi.org/10.1373/clinchem.2018.294124},
   keywords = {SENSITIVITY CARDIAC TROPONIN; CHEST-PAIN SYMPTOMS; HOUR RULE-IN; EARLY-DIAGNOSIS; 2-HOUR ALGORITHM; RELATIVE CHANGES; RAPID RULE; VALIDATION; ABSOLUTE; BIOMARKER},
   language = {eng},
   issn = {0009-9147},
   journal = {Clinical Chemistry},
   title = {Predicting Acute Myocardial Infarction with a Single Blood Draw},
   url = {http://dx.doi.org/10.1373/clinchem.2018.294124},
   volume = {65},
   year = {2019}
}

TY  - JOUR
ID  - 1579477
AU  - Boeddinghaus, Jasper - Nestelberger, Thomas - Badertscher, Patrick - Twerenbold, Raphael - Fitze, Brigitte - Wussler, Desiree - Strebel, Ivo - Gimenez, Maria Rubini - Wildi, Karin - Puelacher, Christian - de Lavallaz, Jeanne du Fay - Oehen, Loris - Walter, Joan - Miro, Oscar - Martin-Sanchez, Javier F. - Morawiec, Beata - Potlukova, Eliska - Keller, Dagmar I. - Reichlin, Tobias - Mueller, Christian - Sabti, Zaid - Freese, Michael - Stelzig, Claudia - Shrestha, Samyut - Schaerli, Nicolas - Kozhuharov, Nikola - Flores, Dayana - Lohrmann, Jens - Biskup, Ewalina - Kloos, Wanda - Osswald, Stefan - Mueller, Deborah - Sazgary, Lorraine - Lopez, Beatriz - Adrada, Esther Rodriguez - Kawecki, Damian - Muzyk, Piotr - Nowalany-Kozielska, Ewa - Pařenica, Jiří - Ganovská, Eva - Meissner, Kathrin - Kulangara, Caroline - Mahfouz, Riham - Hartmann, Beate - Ferel, Ina - Campodarve, Isabel - Rentsch, Katharina - von Eckardstein, Arnold - Buser, Andreas - Geigy, Nicolas
PY  - 2019
TI  - Predicting Acute Myocardial Infarction with a Single Blood Draw
JF  - Clinical Chemistry
VL  - 65
IS  - 3
SP  - 437-450
EP  - 437-450
PB  - Amer. Assoc. Clinical Chemistry
SN  - 00099147
KW  - SENSITIVITY CARDIAC TROPONIN
KW  - CHEST-PAIN SYMPTOMS
KW  - HOUR RULE-IN
KW  - EARLY-DIAGNOSIS
KW  - 2-HOUR ALGORITHM
KW  - RELATIVE CHANGES
KW  - RAPID RULE
KW  - VALIDATION
KW  - ABSOLUTE
KW  - BIOMARKER
UR  - http://dx.doi.org/10.1373/clinchem.2018.294124
L2  - http://dx.doi.org/10.1373/clinchem.2018.294124
N2  - BACKGROUND: We desired to determine cardiac troponin (cTn) concentrations necessary to achieve a positive predictive value (PPV) of >75% for acute myocardial infarction (AMI) to justify immediate admission of patients to a monitored unit and, in general, early coronary angiography. METHODS: In a prospective multicenter diagnostic study enrolling patients presenting to the emergency department with symptoms suggestive of AMI, final diagnoses were adjudicated by 2 independent cardiologists based on clinical information including cardiac imaging. cTn concentrations were measured using 5 different sensitive and high-sensitivity cTn (hs-cTn) assays in a blinded fashion at presentation and serially thereafter. The diagnostic end point was PPV for rule-in of AMI of initial cTn concentrations alone and in combination with early changes. RESULTS: Among 3828 patients, 616 (16%) had an AMI. At presentation, 7% to 14% of patients had cTnT/I concentrations associated with a PPV of >= 75%. Adding absolute or relative changes did not significantly further increase the PPV. PPVs increased from 46.5% (95% CI, 43.6-49.4) for hs-cTnT at presentation >14 ng/L to 78.9% (95% CI, 74.7-82.5) for >52 ng/L (P < 0.001), whereas PPVs in higher hs-cTnT strata remained largely unchanged [e.g., 82.4% (95% CI, 77.5-86.7) for >80 ng/L vs 83.9% (95% CI, 76.0-90.1) for >200 ng/L (P = 0.72)]. The addition of early changes in hs-cTnT further increased the PPV up to 60 ng/L, but not for higher concentrations. CONCLUSIONS: Serial sampling does not seem necessary for predicting AMI and concurrent decision-making in about 10% of patients, as it only marginally increases the PPV for AMI and not in a statistically or clinically significant way. (c) 2018 American Association for Clinical Chemistry
ER  -

BOEDDINGHAUS, Jasper, Thomas NESTELBERGER, Patrick BADERTSCHER, Raphael TWERENBOLD, Brigitte FITZE, Desiree WUSSLER, Ivo STREBEL, Maria Rubini GIMENEZ, Karin WILDI, Christian PUELACHER, Jeanne du Fay DE LAVALLAZ, Loris OEHEN, Joan WALTER, Oscar MIRO, Javier F. MARTIN-SANCHEZ, Beata MORAWIEC, Eliska POTLUKOVA, Dagmar I. KELLER, Tobias REICHLIN, Christian MUELLER, Zaid SABTI, Michael FREESE, Claudia STELZIG, Samyut SHRESTHA, Nicolas SCHAERLI, Nikola KOZHUHAROV, Dayana FLORES, Jens LOHRMANN, Ewalina BISKUP, Wanda KLOOS, Stefan OSSWALD, Deborah MUELLER, Lorraine SAZGARY, Beatriz LOPEZ, Esther Rodriguez ADRADA, Damian KAWECKI, Piotr MUZYK, Ewa NOWALANY-KOZIELSKA, Jiří PAŘENICA, Eva GANOVSKÁ, Kathrin MEISSNER, Caroline KULANGARA, Riham MAHFOUZ, Beate HARTMANN, Ina FEREL, Isabel CAMPODARVE, Katharina RENTSCH, Arnold VON ECKARDSTEIN, Andreas BUSER and Nicolas GEIGY. Predicting Acute Myocardial Infarction with a Single Blood Draw. \textit{Clinical Chemistry}. Washington, USA: Amer. Assoc. Clinical Chemistry, 2019, vol.~65, No~3, p.~437-450. ISSN~0009-9147. Available from: https://dx.doi.org/10.1373/clinchem.2018.294124.

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