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Jaeger, Cedric, MD; Wildi, Karin, MD; Twerenbold, Raphael, MD; Reichlin, Tobias, MD; Rubini Gimenez, Maria, MD; Neuhaus, Jean-Daniel, MD; Grimm, Karin, MD; Boeddinghaus, Jasper, MD; Hillinger, Petra, MD; Nestelberger, Thomas, MD; Singeisen, Helene, MD; Gugala, Mathias, MD; Pretre, Gil, MD; Puelacher, Christian, MD; Wagener, Max, MD; Honegger, Ursina, MSc; Schumacher, Carmela, MSc; Moreno Weidmann, Zoraida, MD; Kreutzinger, Philipp, MD; Krivoshei, Lian, MD; Freese, Michael, RN; Stelzig, Claudia, MS; Dietsche, Sebastian, MS; Ernst, Susanne, MD; Rentsch, Katharina, PhD; Osswald, Stefan, MD; Mueller, Christian, MD
The American heart journal, 01/2016, Letnik: 171, Številka: 1Journal Article
Objective We aimed to prospectively derive and validate a novel 0-/1-hour algorithm using high-sensitivity cardiac troponin I (hs-cTnI) for the early “rule-out” and “rule-in” of acute myocardial infarction (AMI). Methods In a prospective multicenter diagnostic study, we enrolled 1,500 patients presenting with suspected AMI to the emergency department. The final diagnosis was centrally adjudicated by 2 independent cardiologists blinded to hs-cTnI concentrations. The hs-cTnI (Siemens Vista) 0-/1-hour algorithm incorporated measurements performed at baseline and absolute changes within 1 hour, was derived in the first 750 patients (derivation cohort), and then validated in the second 750 (validation cohort). Results Overall, AMI was the final diagnosis in 16% of patients. Applying the hs-cTnI 0-/1-hour algorithm developed in the derivation cohort to the validation cohort, 57% of patients could be classified as “rule-out”; 10%, as “rule-in”; and 33%, as “observe.” In the validation cohort, the sensitivity and the negative predictive value for AMI in the “rule-out” zone were 100% (95% CI 96%-100%) and 100% (95% CI 99%-100%), respectively. The specificity and the positive predictive value (PPV) for AMI in the “rule-in” zone were 96% (95% CI 94%-97%) and 70% (95% CI 60%-79%), respectively. Negative predictive value and positive predictive value of the 0-/1-hour algorithm were higher compared to the standard of care combining hs-cTnI with the electrocardiogram (both P < .001). Conclusion The hs-cTnI 0-/1-hour algorithm performs very well for early rule-out as well as rule-in of AMI. The clinical implications are that used in conjunction with all other clinical information, the 0-/1-hour algorithm will be a safe and effective approach to substantially reduce time to diagnosis.
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Dostop do baze podatkov JCR je dovoljen samo uporabnikom iz Slovenije. Vaš trenutni IP-naslov ni na seznamu dovoljenih za dostop, zato je potrebna avtentikacija z ustreznim računom AAI.
Leto | Faktor vpliva | Izdaja | Kategorija | Razvrstitev | ||||
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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in: SICRIS
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