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Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction

Twerenbold, Raphael and Neumann, Johannes Tobias and Sörensen, Nils Arne and Ojeda, Francisco and Karakas, Mahir and Boeddinghaus, Jasper and Nestelberger, Thomas and Badertscher, Patrick and Rubini Giménez, Maria and Puelacher, Christian and Wildi, Karin and Kozhuharov, Nikola and Breitenbuecher, Dominik and Biskup, Ewelina and du Fay de Lavallaz, Jeanne and Flores, Dayana and Wussler, Desiree and Miró, Òscar and Martín Sánchez, F. Javier and Morawiec, Beata and Parenica, Jiri and Geigy, Nicolas and Keller, Dagmar I. and Zeller, Tanja and Reichlin, Tobias and Blankenberg, Stefan and Westermann, Dirk and Mueller, Christian. (2018) Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction. Journal of the American College of Cardiology, 72 (6). pp. 620-632.

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Official URL: https://edoc.unibas.ch/71182/

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Abstract

The safety of the European Society of Cardiology (ESC) 0/1-h algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin (hs-cTn) has been questioned.; This study aimed to validate the diagnostic performance of the 0/1-h algorithm in a large multicenter study.; The authors prospectively enrolled unselected patients in 6 countries presenting to the emergency department with symptoms suggestive of NSTEMI. Final diagnosis was centrally adjudicated by 2 independent cardiologists. Hs-cTnT and hs-cTnI blood concentrations were measured at presentation and after 1 h. Safety of rule-out was quantified by the negative predictive value (NPV) for NSTEMI, accuracy of rule-in by the positive predictive value (PPV), and overall efficacy by the proportion of patients triaged towards rule-out or rule-in within 1 h.; Prevalence of NSTEMI was 17%. Among 4,368 patients with serial hs-cTnT measurements available, safety of rule-out (NPV 99.8%, 2,488 of 2,493), accuracy of rule-in (PPV 74.5%, 572 of 768), and overall efficacy were high by assigning three-fourths of patients either to rule-out (57%, 2,493 to 4,368) or rule-in (18%, 768 to 4,368). Similarly, among 3,500 patients with serial hs-cTnI measurements, safety of rule-out (NPV 99.7%, 1,528 of 1,533), accuracy of rule-in (PPV 62.3%, 498 of 800), and overall efficacy were high by assigning more than two-thirds of patients either to rule-out (44%, 1,533 of 3,500) or rule-in (23%, 800 of 3,500). Excellent safety was confirmed in multiple subgroup analyses including patients presenting early (≤3 h) after chest pain onset.; The ESC 0/1-h algorithm using hs-cTnT and hs-cTnI is very safe and effective in triaging patients with suspected NSTEMI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE]; NCT00470587; and Biomarkers in Acute Cardiac Care [BACC]; NCT02355457).
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:Elsevier
ISSN:0735-1097
e-ISSN:1558-3597
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
Language:English
Identification Number:
Last Modified:23 Oct 2019 14:12
Deposited On:23 Oct 2019 14:11

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