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One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I

Rubini Gimenez, Maria and Twerenbold, Raphael and Jaeger, Cedric and Schindler, Christian and Puelacher, Christian and Wildi, Karin and Reichlin, Tobias and Haaf, Philip and Merk, Salome and Honegger, Ursina and Wagener, Max and Druey, Sophie and Schumacher, Carmela and Krivoshei, Lian and Hillinger, Petra and Herrmann, Thomas and Campodarve, Isabel and Rentsch, Katharina and Bassetti, Stefano and Osswald, Stefan and Mueller, Christian. (2015) One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I. The American journal of medicine, Vol. 128, H. 8 , S. 861-870.e4.

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Official URL: http://edoc.unibas.ch/dok/A6420015

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Abstract

We aimed to prospectively derive and validate a novel 1h-algorithm using high-sensitivity cardiac troponin I (hs-cTnI) for early rule-out and rule-in of acute myocardial infarction.; We performed a prospective multicenter diagnostic study enrolling 1811 patients with suspected acute myocardial infarction. The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including coronary angiography, echocardiography, follow-up data, and serial measurements of hs-cTnT (but not hs-cTnI). The hs-cTnI 1h-algorithm, incorporating measurements performed at baseline and absolute changes within 1 hour, was derived in a randomly selected sample of 906 patients (derivation cohort), and then validated in the remaining 905 patients (validation cohort).; Acute myocardial infarction was the final diagnosis in 18% of patients. After applying the hs-cTnI 1h-algorithm developed in the derivation cohort to the validation cohort, 50.5% of patients could be classified as "rule-out," 19% as "rule-in," 30.5% as "observe." In the validation cohort, the negative predictive value for acute myocardial infarction in the "rule-out" zone was 99.6% (95% confidence interval, 98.4%-100%), and the positive predictive value for acute myocardial infarction in the "rule-in" zone was 73.9% (95% confidence interval, 66.7%-80.2%). Negative predictive value of the 1h-algorithm was higher compared with the classical dichotomous interpretation of hs-cTnI and to the standard of care combining hs-cTnI with the electrocardiogram (both P > .001). Positive predictive value also was higher compared with the standard of care (P > .001).; Using a simple algorithm incorporating baseline hs-cTnI values and the absolute change within the first hour allows safe rule-out as well as accurate rule-in of acute myocardial infarction in 70% of patients presenting with suspected acute myocardial infarction.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Biostatistics > Biostatistics - Frequency Modelling (Schindler)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
UniBasel Contributors:Schindler, Christian
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Elsevier
ISSN:0002-9343
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:02 Oct 2015 10:01
Deposited On:02 Oct 2015 10:01

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