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Novel Criteria for the Observe-Zone of the ESC 0/1h-hs-cTnT Algorithm

Lopez-Ayala, Pedro and Nestelberger, Thomas and Boeddinghaus, Jasper and Koechlin, Luca and Ratmann, Paul David and Strebel, Ivo and Gehrke, Juliane and Meier, Severin and Walter, Joan and Rubini Gimenez, Maria and Mutschler, Eugenio and Miró, Òscar and López-Barbeito, Beatriz and Martín-Sánchez, Francisco Javier and Rodríguez-Adrada, Esther and Keller, Dagmar I. and Newby, L. Kristin and Twerenbold, Raphael and Giannitsis, Evangelos and Lindahl, Bertil and Mueller, Christian and Apace, and Trapid-AMI Investigators�, . (2021) Novel Criteria for the Observe-Zone of the ESC 0/1h-hs-cTnT Algorithm. Circulation, 144 (10). pp. 773-787.

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Official URL: https://edoc.unibas.ch/87839/

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Abstract

The non-ST-segment-elevation myocardial infarction (NSTEMI) guidelines of the European Society of Cardiology (ESC) recommend a 3h cardiac troponin determination in patients triaged to the observe-zone of the ESC 0/1h-algorithm; however, no specific cutoff for further triage is endorsed. Recently, a specific cutoff for 0/3h high-sensitivity cardiac troponin T (hs-cTnT) change (7 ng/L) was proposed, warranting external validation.; Patients presenting with acute chest discomfort to the emergency department were prospectively enrolled into an international multicenter diagnostic study. Final diagnoses were centrally adjudicated by 2 independent cardiologists applying the fourth universal definition of myocardial infarction, on the basis of complete cardiac workup, cardiac imaging, and serial hs-cTnT. Hs-cTnT concentrations were measured at presentation, after 1 hour, and after 3 hours. The objective was to externally validate the proposed cutoff, and if necessary, derive and internally as well as externally validate novel 0/3h-criteria for the observe-zone of the ESC 0/1h-hs-cTnT-algorithm in an independent multicenter cohort.; Among 2076 eligible patients, application of the ESC 0/1h-hs-cTnT-algorithm triaged 1512 patients (72.8%) to either rule out or rule in NSTEMI, leaving 564 patients (27.2%) in the observe-zone (adjudicated NSTEMI prevalence, 120/564 patients, 21.3%). The suggested 0/3h-hs-cTnT-change of <7 ng/L triaged 517 patients (91.7%) toward rule-out, resulting in a sensitivity of 33.3% (95% CI, 25.5-42.2), missing 80 patients with NSTEMI, and ≥7 ng/L triaged 47 patients toward rule-in (8.3%), resulting in a specificity of 98.4% (95% CI, 96.8-99.2). Novel derived 0/3h-criteria for the observe-zone patients ruled out NSTEMI with a 3h hs-cTnT concentration <15 ng/L and a 0/3h-hs-cTnT absolute change <4 ng/L, triaging 138 patients (25%) toward rule-out, resulting in a sensitivity of 99.2% (95% CI, 96.0-99.9), missing 1 patient with NSTEMI. A 0/3h-hs-cTnT absolute change ≥6 ng/L triaged 63 patients (11.2%) toward rule-in, resulting in a specificity of 98% (95% CI, 96.2-98.9) Thereby, the novel 0/3h-criteria reduced the number of patients in the observe zone by 36%s and the number of type 1 myocardial infarction by 50%. Findings were confirmed in both internal and external validation.; A combination of a 3h-hs-cTnT concentration (<15 ng/L) and a 0/3h absolute change (<4 ng/L) is necessary to safely rule out NSTEMI in patients remaining in the observe-zone of the ESC 0/1h-hs-cTnT-algorithm. Registration: URL: https://clinicaltrials.gov; Unique identifier: NCT00470587.
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:Lopez Ayala, Pedro and Nestelberger, Thomas and Boeddinghaus, Jasper and Koechlin, Luca and Ratmann, Paul David and Strebel, Ivo and Gehrke, Juliane and Walter, Joan Elias and Rubini Giménez, Maria and Twerenbold, Raphael and Miro, Oscar and Müller, Christian
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Lippincott, Williams & Wilkins
ISSN:0009-7322
e-ISSN:1524-4539
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
Language:English
Language:English
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Last Modified:25 May 2022 06:51
Deposited On:24 May 2022 09:11

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