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- Title
2015 - Baseline plus 1-hour high-sensitivity cardiac troponin T improved early rule-out and rule-in of acute MI.
- Authors
Worster, Andrew
- Abstract
Question: In patients with suspected acute myocardial infarction (AMI), how well does an algorithm using baseline and 1-hour high-sensitivity cardiac troponin T (hs-cTnT) levels rule out and rule in AMI? Methods Design: Prospective cohort study for validation of a previously developed algorithm (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study). ClinicalTrials.gov NCT00470587. Setting: 6 emergency departments (EDs) in Switzerland, Spain, and Italy. Patients: 1320 of 1656 patients (median age 60 y, 69% men) who presented to the ED within 12 hours of onset of nontraumatic chest pain or other symptoms suggestive of AMI. Exclusion criteria were kidney failure requiring dialysis or ST-elevation MI. Description of prediction guide: AMI ruled out or in based on baseline hs-cTnT and absolute change in hs-cTnT within the first hour. Through use of the algorithm, AMI was ruled out when baseline hs-cTnT was <12 ng/L and absolute change within 1 hour was < 3 ng/L. AMI was ruled in when baseline hs-cTnT was ≥ 52 ng/L or absolute change within 1 hour was ≥ 5 ng/L. If neither criterion was met, patients were considered to be in the observation zone. Outcomes: AMI adjudicated by 2 independent cardiologists using information in medical records from ED presentation to 90-day follow-up, including patient history, physical examination, coronary angiography, echocardiography, follow-up data, and serial hs-cTnT measurements. Main results: 229 (17%) patients had AMI. AMI was ruled out in 786 (60%) patients and ruled in in 216 (16%) patients; 318 patients (24%) were in the observation zone. Accuracy of the algorithm is shown in the Table. The area under the curve was 0.96 (95% CI 0.95 to 0.97) for the algorithm, 0.93 (CI 0.92 to 0.95) for hs-cTnT at presentation alone, and 0.96 (CI 0.95 to 0.97) for the combination of hs-cTnT at presentation and absolute change at 2 hours. Conclusion: In patients presenting to the emergency department with suspected acute myocardial infarction (AMI), an algorithm based on baseline and 1-hour high-sensitivity cardiac troponin T had 99.6% sensitivity for ruling out and 95.7% specificity for ruling in AMI.</abs.txt>
- Subjects
ITALY; SPAIN; SWITZERLAND; MYOCARDIAL infarction diagnosis; ALGORITHMS; BIOMARKERS; CONFIDENCE intervals; DECISION making; EMERGENCY medical services; HOSPITAL emergency services; LONGITUDINAL method; RESEARCH methodology; EVALUATION of medical care; MEDICAL cooperation; HEALTH outcome assessment; PATIENTS; RESEARCH; PREDICTIVE tests; ACUTE diseases; EARLY diagnosis; TROPONIN; DESCRIPTIVE statistics
- Publication
ACP Journal Club, 2015, Vol 163, Issue 4, p1
- ISSN
1056-8751
- Publication type
Article
- DOI
10.7326/ACPJC-2015-163-4-012