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Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction

Boeddinghaus, Jasper and Nestelberger, Thomas and Twerenbold, Raphael and Neumann, Johannes Tobias and Lindahl, Bertil and Giannitsis, Evangelos and Sörensen, Nils Arne and Badertscher, Patrick and Jann, Janina E. and Wussler, Desiree and Puelacher, Christian and Rubini Giménez, Maria and Wildi, Karin and Strebel, Ivo and Du Fay de Lavallaz, Jeanne and Selman, Farah and Sabti, Zaid and Kozhuharov, Nikola and Potlukova, Eliska and Rentsch, Katharina and Miró, Òscar and Martin-Sanchez, F. Javier and Morawiec, Beata and Parenica, Jiri and Lohrmann, Jens and Kloos, Wanda and Buser, Andreas and Geigy, Nicolas and Keller, Dagmar I. and Osswald, Stefan and Reichlin, Tobias and Westermann, Dirk and Blankenberg, Stefan and Mueller, Christian and Apace, Bacc und Trapid-AMI Investigators, . (2018) Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction. European heart journal, 39 (42). pp. 3780-3794.

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Official URL: https://edoc.unibas.ch/71166/

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Abstract

We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1h-algorithms and to derive and externally validate alternative cut-offs specific to older patients.; We prospectively enrolled patients presenting to the emergency department (ED) with symptoms suggestive of acute myocardial infarction in three large diagnostic studies. Final diagnoses were adjudicated by two independent cardiologists. High-sensitivity cardiac troponin (hs-cTn) T and I concentrations were measured at presentation and after 1 h. Patients were stratified according to age [<55 years (young), ≥55 to <70 years (middle-age), ≥70 years (old)]. Rule-out safety of the ESC hs-cTnT 0/1h-algorithm was very high in all age-strata: sensitivity 100% [95% confidence interval (95% CI) 94.9-100] in young, 99.3% (95% CI 96.0-99.9) in middle-age, and 99.3% (95% CI 97.5-99.8) in old patients. Accuracy of rule-in decreased with age: specificity 97.0% (95% CI 95.8-97.9) in young, 96.1% (95% CI 94.5-97.2) in middle-age, and 92.7% (95% CI 90.7-94.3) in older patients. Triage efficacy decreased with increasing age (young 93%, middle-age 80%, old 55%, P < 0.001). Similar results were found for the ESC hs-cTnT 0/1h-algorithm. Alternative, slightly higher cut-off concentrations optimized for older patients maintained very high safety of rule-out, increased specificity of rule-in (P < 0.01), reduced overall efficacy for hs-cTnT (P < 0.01), while maintaining efficacy for hs-cTnI. Findings were confirmed in two validation cohorts (n = 2767).; While safety of the ESC 0/1h-algorithms remained very high, increasing age significantly reduced overall efficacy and the accuracy of rule-in. Alternative slightly higher cut-off concentrations may be considered for older patients, particularly if using hs-cTnI.; https://clinicaltrials.gov/ct2/show/NCT00470587, number NCT00470587 and NCT02355457 (BACC).
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
UniBasel Contributors:Müller, Christian
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Oxford University Press
ISSN:0195-668X
e-ISSN:1522-9645
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
Identification Number:
Last Modified:05 Jul 2019 12:50
Deposited On:05 Jul 2019 12:34

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