Your browser doesn't support javascript.
loading
Two-Hour Algorithm for Rapid Triage of Suspected Acute Myocardial Infarction Using a High-Sensitivity Cardiac Troponin I Assay.
Nestelberger, Thomas; Boeddinghaus, Jasper; Greenslade, Jaimi; Parsonage, William A; Than, Martin; Wussler, Desiree; Lopez-Ayala, Pedro; Zimmermann, Tobias; Meier, Mario; Troester, Valentina; Badertscher, Patrick; Koechlin, Luca; Wildi, Karin; Anwar, Mahnoor; Freese, Michael; Keller, Dagmar I; Reichlin, Tobias; Twerenbold, Raphael; Cullen, Louise; Mueller, Christian.
Afiliación
  • Nestelberger T; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Boeddinghaus J; GREAT network.
  • Greenslade J; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Parsonage WA; GREAT network.
  • Than M; Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Wussler D; Royal Brisbane and Women's Hospital, Brisbane, Australia.
  • Lopez-Ayala P; Queensland University of Technology, Brisbane, Australia.
  • Zimmermann T; University of Queensland, Brisbane, Australia.
  • Meier M; Royal Brisbane and Women's Hospital, Brisbane, Australia.
  • Troester V; Queensland University of Technology, Brisbane, Australia.
  • Badertscher P; University of Queensland, Brisbane, Australia.
  • Koechlin L; Emergency Department, Christchurch Hospital, Christchurch, New Zealand.
  • Wildi K; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Anwar M; GREAT network.
  • Freese M; Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Keller DI; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Reichlin T; GREAT network.
  • Twerenbold R; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Cullen L; GREAT network.
  • Mueller C; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
Clin Chem ; 65(11): 1437-1447, 2019 11.
Article en En | MEDLINE | ID: mdl-31570634
BACKGROUND: We aimed to derive and externally validate a 0/2-h algorithm using the high-sensitivity cardiac troponin I (hs-cTnI)-Access assay. METHODS: We enrolled patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction (AMI) in 2 prospective diagnostic studies using central adjudication. Two independent cardiologists adjudicated the final diagnosis, including all available medical information including cardiac imaging. hs-cTnI-Access concentrations were measured at presentation and after 2 h in a blinded fashion. RESULTS: AMI was the adjudicated final diagnosis in 164 of 1131 (14.5%) patients in the derivation cohort. Rule-out by the hs-cTnI-Access 0/2-h algorithm was defined as 0-h hs-cTnI-Access concentration <4 ng/L in patients with an onset of chest pain >3 h (direct rule-out) or a 0-h hs-cTnI-Access concentration <5 ng/L and an absolute change within 2 h <5 ng/L in all other patients. Derived thresholds for rule-in were a 0-h hs-cTnI-Access concentration ≥50 ng/L (direct rule-in) or an absolute change within 2 h ≥20 ng/L. In the derivation cohort, these cutoffs ruled out 55% of patients with a negative predictive value (NPV) of 99.8% (95% CI, 99.3-100) and sensitivity of 99.4% (95% CI, 96.5-99.9), and ruled in 30% of patients with a positive predictive value (PPV) of 73% (95% CI, 66.1-79). In the validation cohort, AMI was the adjudicated final diagnosis in 88 of 1280 (6.9%) patients. These cutoffs ruled out 77.9% of patients with an NPV of 99.8% (95% CI, 99.3-100) and sensitivity of 97.7% (95% CI, 92.0-99.7), and ruled in 5.8% of patients with a PPV of 77% (95% CI, 65.8-86) in the validation cohort. CONCLUSIONS: Safety and efficacy of the l hs-cTnI-Access 0/2-h algorithm for triage toward rule-out or rule-in of AMI are very high. TRIAL REGISTRATION: APACE, NCT00470587; ADAPT, ACTRN1261100106994; IMPACT, ACTRN12611000206921.
Asunto(s)
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Algoritmos / Triaje / Troponina I / Infarto del Miocardio Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Chem Asunto de la revista: QUIMICA CLINICA Año: 2019 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Algoritmos / Triaje / Troponina I / Infarto del Miocardio Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Chem Asunto de la revista: QUIMICA CLINICA Año: 2019 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Reino Unido