Format

Send to

Choose Destination
CMAJ. 2015 May 19;187(8):E243-52. doi: 10.1503/cmaj.141349. Epub 2015 Apr 13.

Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay.

Author information

1
Department of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
2
Department of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland chmueller@uhbs.ch.

Abstract

BACKGROUND:

We aimed to prospectively validate a novel 1-hour algorithm using high-sensitivity cardiac troponin T measurement for early rule-out and rule-in of acute myocardial infarction (MI).

METHODS:

In a multicentre study, we enrolled 1320 patients presenting to the emergency department with suspected acute MI. The high-sensitivity cardiac troponin T 1-hour algorithm, incorporating baseline values as well as absolute changes within the first hour, was validated against the final diagnosis. The final diagnosis was then adjudicated by 2 independent cardiologists using all available information, including coronary angiography, echocardiography, follow-up data and serial measurements of high-sensitivity cardiac troponin T levels.

RESULTS:

Acute MI was the final diagnosis in 17.3% of patients. With application of the high-sensitivity cardiac troponin T 1-hour algorithm, 786 (59.5%) patients were classified as "rule-out," 216 (16.4%) were classified as "rule-in" and 318 (24.1%) were classified to the "observational zone." The sensitivity and the negative predictive value for acute MI in the rule-out zone were 99.6% (95% confidence interval [CI] 97.6%-99.9%) and 99.9% (95% CI 99.3%-100%), respectively. The specificity and the positive predictive value for acute MI in the rule-in zone were 95.7% (95% CI 94.3%-96.8%) and 78.2% (95% CI 72.1%-83.6%), respectively. The 1-hour algorithm provided higher negative and positive predictive values than the standard interpretation of highsensitivity cardiac troponin T using a single cut-off level (both p < 0.05). Cumulative 30-day mortality was 0.0%, 1.6% and 1.9% in patients classified in the rule-out, observational and rule-in groups, respectively (p = 0.001).

INTERPRETATION:

This rapid strategy incorporating high-sensitivity cardiac troponin T baseline values and absolute changes within the first hour substantially accelerated the management of suspected acute MI by allowing safe rule-out as well as accurate rule-in of acute MI in 3 out of 4 patients.

TRIAL REGISTRATION:

ClinicalTrials.gov, NCT00470587.

PMID:
25869867
PMCID:
PMC4435896
DOI:
10.1503/cmaj.141349
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center