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Two-Hour Algorithm for Triage toward Rule-Out and Rule-In of Acute Myocardial Infarction by Use of High-Sensitivity Cardiac Troponin I

The early triage of patients toward rule-out and rule-in of acute myocardial infarction (AMI) is challenging. Therefore, we aimed to develop a 2-h algorithm that uses high-sensitivity cardiac troponin I (hs-cTnI). We prospectively enrolled 1435 (derivation cohort) and 1194 (external validation cohor... Full description

Journal Title: Clinical chemistry March 2016, Vol.62(3), pp.494-504
Main Author: Boeddinghaus, Jasper
Other Authors: Reichlin, Tobias , Cullen, Louise , Greenslade, Jaimi H , Parsonage, William A , Hammett, Christopher , Pickering, John W , Hawkins, Tracey , Aldous, Sally , Twerenbold, Raphael , Wildi, Karin , Nestelberger, Thomas , Grimm, Karin , Rubini-Gimenez, Maria , Puelacher, Christian , Kern, Vera , Rentsch, Katharina , Than, Martin , Mueller, Christian
Format: Electronic Article Electronic Article
Language: English
Subjects:
ID: E-ISSN: 1530-8561 ; PMID: 26797687 Version:1 ; DOI: 10.1373/clinchem.2015.249508
Link: http://pubmed.gov/26797687
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title: Two-Hour Algorithm for Triage toward Rule-Out and Rule-In of Acute Myocardial Infarction by Use of High-Sensitivity Cardiac Troponin I
format: Article
creator:
  • Boeddinghaus, Jasper
  • Reichlin, Tobias
  • Cullen, Louise
  • Greenslade, Jaimi H
  • Parsonage, William A
  • Hammett, Christopher
  • Pickering, John W
  • Hawkins, Tracey
  • Aldous, Sally
  • Twerenbold, Raphael
  • Wildi, Karin
  • Nestelberger, Thomas
  • Grimm, Karin
  • Rubini-Gimenez, Maria
  • Puelacher, Christian
  • Kern, Vera
  • Rentsch, Katharina
  • Than, Martin
  • Mueller, Christian
subjects:
  • Algorithms
  • Myocardial Infarction -- Blood
  • Troponin I -- Blood
ispartof: Clinical chemistry, March 2016, Vol.62(3), pp.494-504
description: The early triage of patients toward rule-out and rule-in of acute myocardial infarction (AMI) is challenging. Therefore, we aimed to develop a 2-h algorithm that uses high-sensitivity cardiac troponin I (hs-cTnI). We prospectively enrolled 1435 (derivation cohort) and 1194 (external validation cohort) patients presenting with suspected AMI to the emergency department. The final diagnosis was adjudicated by 2 independent cardiologists. hs-cTnI was measured at presentation and after 2 h in a blinded fashion. We derived and validated a diagnostic algorithm incorporating hs-cTnI values at presentation and absolute changes within the first 2 h. AMI was the final diagnosis in 17% of patients in the derivation and 13% in the validation cohort. The 2-h algorithm developed in the derivation cohort classified 56% of patients as rule-out, 17% as rule-in, and 27% as observation. Resulting diagnostic sensitivity and negative predictive value (NPV) were 99.2% and 99.8% for rule-out; specificity and positive predictive value (PPV) were 95.2% and 75.8% for rule-in. Applying the 2-h algorithm in the external validation cohort, 60% of patients were classified as rule-out, 13% as rule-in, and 27% as observation. Diagnostic sensitivity and NPV were 98.7% and 99.7% for rule-out; specificity and PPV were 97.4% and 82.2% for rule-in. Thirty-day survival was 100% for rule-out patients in both cohorts. A simple algorithm incorporating hs-cTnI baseline values and absolute 2-h changes allowed a triage toward safe rule-out or accurate rule-in of AMI in the majority of patients.
language: eng
source:
identifier: E-ISSN: 1530-8561 ; PMID: 26797687 Version:1 ; DOI: 10.1373/clinchem.2015.249508
fulltext: fulltext
issn:
  • 15308561
  • 1530-8561
url: Link


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titleTwo-Hour Algorithm for Triage toward Rule-Out and Rule-In of Acute Myocardial Infarction by Use of High-Sensitivity Cardiac Troponin I
creatorBoeddinghaus, Jasper ; Reichlin, Tobias ; Cullen, Louise ; Greenslade, Jaimi H ; Parsonage, William A ; Hammett, Christopher ; Pickering, John W ; Hawkins, Tracey ; Aldous, Sally ; Twerenbold, Raphael ; Wildi, Karin ; Nestelberger, Thomas ; Grimm, Karin ; Rubini-Gimenez, Maria ; Puelacher, Christian ; Kern, Vera ; Rentsch, Katharina ; Than, Martin ; Mueller, Christian
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subjectAlgorithms ; Myocardial Infarction -- Blood ; Troponin I -- Blood
descriptionThe early triage of patients toward rule-out and rule-in of acute myocardial infarction (AMI) is challenging. Therefore, we aimed to develop a 2-h algorithm that uses high-sensitivity cardiac troponin I (hs-cTnI). We prospectively enrolled 1435 (derivation cohort) and 1194 (external validation cohort) patients presenting with suspected AMI to the emergency department. The final diagnosis was adjudicated by 2 independent cardiologists. hs-cTnI was measured at presentation and after 2 h in a blinded fashion. We derived and validated a diagnostic algorithm incorporating hs-cTnI values at presentation and absolute changes within the first 2 h. AMI was the final diagnosis in 17% of patients in the derivation and 13% in the validation cohort. The 2-h algorithm developed in the derivation cohort classified 56% of patients as rule-out, 17% as rule-in, and 27% as observation. Resulting diagnostic sensitivity and negative predictive value (NPV) were 99.2% and 99.8% for rule-out; specificity and positive predictive value (PPV) were 95.2% and 75.8% for rule-in. Applying the 2-h algorithm in the external validation cohort, 60% of patients were classified as rule-out, 13% as rule-in, and 27% as observation. Diagnostic sensitivity and NPV were 98.7% and 99.7% for rule-out; specificity and PPV were 97.4% and 82.2% for rule-in. Thirty-day survival was 100% for rule-out patients in both cohorts. A simple algorithm incorporating hs-cTnI baseline values and absolute 2-h changes allowed a triage toward safe rule-out or accurate rule-in of AMI in the majority of patients.
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titleTwo-Hour Algorithm for Triage toward Rule-Out and Rule-In of Acute Myocardial Infarction by Use of High-Sensitivity Cardiac Troponin I
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2AMI was the final diagnosis in 17% of patients in the derivation and 13% in the validation cohort. The 2-h algorithm developed in the derivation cohort classified 56% of patients as rule-out, 17% as rule-in, and 27% as observation. Resulting diagnostic sensitivity and negative predictive value (NPV) were 99.2% and 99.8% for rule-out; specificity and positive predictive value (PPV) were 95.2% and 75.8% for rule-in. Applying the 2-h algorithm in the external validation cohort, 60% of patients were classified as rule-out, 13% as rule-in, and 27% as observation. Diagnostic sensitivity and NPV were 98.7% and 99.7% for rule-out; specificity and PPV were 97.4% and 82.2% for rule-in. Thirty-day survival was 100% for rule-out patients in both cohorts.
3A simple algorithm incorporating hs-cTnI baseline values and absolute 2-h changes allowed a triage toward safe rule-out or accurate rule-in of AMI in the majority of patients.
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abstractThe early triage of patients toward rule-out and rule-in of acute myocardial infarction (AMI) is challenging. Therefore, we aimed to develop a 2-h algorithm that uses high-sensitivity cardiac troponin I (hs-cTnI).
doi10.1373/clinchem.2015.249508
pmid26797687
date2016-03-01