Two-Hour Algorithm for Triage toward Rule-Out and Rule-In of Acute Myocardial Infarction by Use of High-Sensitivity Cardiac Troponin I.
- Boeddinghaus J Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, and Department of Internal Medicine, University Hospital Basel, Basel, Switzerland;
- Reichlin T Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, and.
- Cullen L Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Public Health, The Queensland University of Technology, Brisbane, Australia;
- Greenslade JH Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Public Health, The Queensland University of Technology, Brisbane, Australia;
- Parsonage WA School of Public Health, The Queensland University of Technology, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia;
- Hammett C School of Medicine, The University of Queensland, Brisbane, Australia;
- Pickering JW Department of Medicine, University of Otago, Christchurch, New Zealand; Emergency Department, Christchurch Hospital, Christchurch, New Zealand;
- Hawkins T Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Public Health, The Queensland University of Technology, Brisbane, Australia;
- Aldous S Emergency Department, Christchurch Hospital, Christchurch, New Zealand;
- Twerenbold R Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, and.
- Wildi K Cardiovascular Research Institute Basel (CRIB).
- Nestelberger T Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, and Department of Internal Medicine, University Hospital Basel, Basel, Switzerland;
- Grimm K Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, and Department of Internal Medicine, University Hospital Basel, Basel, Switzerland;
- Rubini-Gimenez M Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, and.
- Puelacher C Cardiovascular Research Institute Basel (CRIB).
- Kern V Cardiovascular Research Institute Basel (CRIB).
- Rentsch K Laboratory Medicine, University Hospital Basel, Basel, Switzerland.
- Than M Emergency Department, Christchurch Hospital, Christchurch, New Zealand;
- Mueller C Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, and christian.mueller@usb.ch.
- 2016-01-23
Published in:
- Clinical chemistry. - 2016
Algorithms
Female
Humans
Limit of Detection
Male
Middle Aged
Myocardial Infarction
Predictive Value of Tests
Prospective Studies
Time Factors
Troponin I
English
BACKGROUND
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).
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
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).
METHODS
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.
RESULTS
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.
CONCLUSIONS
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
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1373/clinchem.2015.249508
- PMID 26797687
- Persistent URL
- https://sonar.ch/global/documents/194845
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