Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T

Christian Mueller; Evangelos Giannitsis; Michael Christ; Jorge Ordonez-Llanos; Christopher DeFilippi; James McCord; Richard Body; Mauro  Panteghini; Tomas Jernberg; Mario Plebani; Franck Verschuren; John French; Robert Christenson; Silvia Weiser; Garnet Bendig; Peter Dilba; Bertil Lindahl; Daniel Horner

doi:10.1016/j.annemergmed.2015.11.013

Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T

Christian Mueller, Evangelos Giannitsis, Michael Christ, Jorge Ordonez-Llanos, Christopher DeFilippi, James McCord, Richard Body, Mauro Panteghini, Tomas Jernberg, Mario Plebani, Franck Verschuren, John French, Robert Christenson, Silvia Weiser, Garnet Bendig, Peter Dilba, Bertil Lindahl, Daniel Horner

Research output: Contribution to journal › Article › peer-review

Abstract

STUDY OBJECTIVE: We aim to prospectively validate the diagnostic accuracy of the recently developed 0-h/1-h algorithm, using high-sensitivity cardiac troponin T (hs-cTnT) for the early rule-out and rule-in of acute myocardial infarction.

METHODS: We enrolled patients presenting with suspected acute myocardial infarction and recent (<6 hours) onset of symptoms to the emergency department in a global multicenter diagnostic study. Hs-cTnT (Roche Diagnostics) and sensitive cardiac troponin I (Siemens Healthcare) were measured at presentation and after 1 hour, 2 hours, and 4 to 14 hours in a central laboratory. Patient triage according to the predefined hs-cTnT 0-hour/1-hour algorithm (hs-cTnT below 12 ng/L and Δ1 hour below 3 ng/L to rule out; hs-cTnT at least 52 ng/L or Δ1 hour at least 5 ng/L to rule in; remaining patients to the "observational zone") was compared against a centrally adjudicated final diagnosis by 2 independent cardiologists (reference standard). The final diagnosis was based on all available information, including coronary angiography and echocardiography results, follow-up data, and serial measurements of sensitive cardiac troponin I, whereas adjudicators remained blinded to hs-cTnT.

RESULTS: Among 1,282 patients enrolled, acute myocardial infarction was the final diagnosis for 213 (16.6%) patients. Applying the hs-cTnT 0-hour/1-hour algorithm, 813 (63.4%) patients were classified as rule out, 184 (14.4%) were classified as rule in, and 285 (22.2%) were triaged to the observational zone. This resulted in a negative predictive value and sensitivity for acute myocardial infarction of 99.1% (95% confidence interval [CI] 98.2% to 99.7%) and 96.7% (95% CI 93.4% to 98.7%) in the rule-out zone (7 patients with false-negative results), a positive predictive value and specificity for acute myocardial infarction of 77.2% (95% CI 70.4% to 83.0%) and 96.1% (95% CI 94.7% to 97.2%) in the rule-in zone, and a prevalence of acute myocardial infarction of 22.5% in the observational zone.

CONCLUSION: The hs-cTnT 0-hour/1-hour algorithm performs well for early rule-out and rule-in of acute myocardial infarction.

Original language	English
Pages (from-to)	76-87.e4
Number of pages	16
Journal	Annals of Emergency Medicine
Volume	68
Issue number	1
Early online date	12 Jan 2016
DOIs	https://doi.org/10.1016/j.annemergmed.2015.11.013 https://doi.org/10.1016/j.annemergmed.2015.11.013
Publication status	Published - Jul 2016

Keywords

Aged
Aged, 80 and over
Algorithms
Electrocardiography
Emergency Service, Hospital
Female
Humans
Male
Middle Aged
Myocardial Infarction
Time Factors
Troponin T
Journal Article
Multicenter Study

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Mueller, C., Giannitsis, E., Christ, M., Ordonez-Llanos, J., DeFilippi, C., McCord, J., Body, R., Panteghini, M., Jernberg, T., Plebani, M., Verschuren, F., French, J., Christenson, R., Weiser, S., Bendig, G., Dilba, P., Lindahl, B., & Horner, D. (2016). Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T. Annals of Emergency Medicine, 68(1), 76-87.e4. https://doi.org/10.1016/j.annemergmed.2015.11.013, https://doi.org/10.1016/j.annemergmed.2015.11.013

@article{598917635d83465d8729e4303aa784a5,

title = "Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T",

abstract = "STUDY OBJECTIVE: We aim to prospectively validate the diagnostic accuracy of the recently developed 0-h/1-h algorithm, using high-sensitivity cardiac troponin T (hs-cTnT) for the early rule-out and rule-in of acute myocardial infarction.METHODS: We enrolled patients presenting with suspected acute myocardial infarction and recent (<6 hours) onset of symptoms to the emergency department in a global multicenter diagnostic study. Hs-cTnT (Roche Diagnostics) and sensitive cardiac troponin I (Siemens Healthcare) were measured at presentation and after 1 hour, 2 hours, and 4 to 14 hours in a central laboratory. Patient triage according to the predefined hs-cTnT 0-hour/1-hour algorithm (hs-cTnT below 12 ng/L and Δ1 hour below 3 ng/L to rule out; hs-cTnT at least 52 ng/L or Δ1 hour at least 5 ng/L to rule in; remaining patients to the {"}observational zone{"}) was compared against a centrally adjudicated final diagnosis by 2 independent cardiologists (reference standard). The final diagnosis was based on all available information, including coronary angiography and echocardiography results, follow-up data, and serial measurements of sensitive cardiac troponin I, whereas adjudicators remained blinded to hs-cTnT.RESULTS: Among 1,282 patients enrolled, acute myocardial infarction was the final diagnosis for 213 (16.6%) patients. Applying the hs-cTnT 0-hour/1-hour algorithm, 813 (63.4%) patients were classified as rule out, 184 (14.4%) were classified as rule in, and 285 (22.2%) were triaged to the observational zone. This resulted in a negative predictive value and sensitivity for acute myocardial infarction of 99.1% (95% confidence interval [CI] 98.2% to 99.7%) and 96.7% (95% CI 93.4% to 98.7%) in the rule-out zone (7 patients with false-negative results), a positive predictive value and specificity for acute myocardial infarction of 77.2% (95% CI 70.4% to 83.0%) and 96.1% (95% CI 94.7% to 97.2%) in the rule-in zone, and a prevalence of acute myocardial infarction of 22.5% in the observational zone.CONCLUSION: The hs-cTnT 0-hour/1-hour algorithm performs well for early rule-out and rule-in of acute myocardial infarction.",

keywords = "Aged, Aged, 80 and over, Algorithms, Electrocardiography, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Myocardial Infarction, Time Factors, Troponin T, Journal Article, Multicenter Study",

author = "Christian Mueller and Evangelos Giannitsis and Michael Christ and Jorge Ordonez-Llanos and Christopher DeFilippi and James McCord and Richard Body and Mauro Panteghini and Tomas Jernberg and Mario Plebani and Franck Verschuren and John French and Robert Christenson and Silvia Weiser and Garnet Bendig and Peter Dilba and Bertil Lindahl and Daniel Horner",

year = "2016",

month = jul,

doi = "10.1016/j.annemergmed.2015.11.013",

language = "English",

volume = "68",

pages = "76--87.e4",

journal = "Annals of Emergency Medicine",

issn = "0196-0644",

publisher = "Mosby, Incorporated",

number = "1",

}

Mueller, C, Giannitsis, E, Christ, M, Ordonez-Llanos, J, DeFilippi, C, McCord, J, Body, R, Panteghini, M, Jernberg, T, Plebani, M, Verschuren, F, French, J, Christenson, R, Weiser, S, Bendig, G, Dilba, P, Lindahl, B & Horner, D 2016, 'Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T', Annals of Emergency Medicine, vol. 68, no. 1, pp. 76-87.e4. https://doi.org/10.1016/j.annemergmed.2015.11.013, https://doi.org/10.1016/j.annemergmed.2015.11.013

TY - JOUR

T1 - Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T

AU - Mueller, Christian

AU - Giannitsis, Evangelos

AU - Christ, Michael

AU - Ordonez-Llanos, Jorge

AU - DeFilippi, Christopher

AU - McCord, James

AU - Body, Richard

AU - Panteghini, Mauro

AU - Jernberg, Tomas

AU - Plebani, Mario

AU - Verschuren, Franck

AU - French, John

AU - Christenson, Robert

AU - Weiser, Silvia

AU - Bendig, Garnet

AU - Dilba, Peter

AU - Lindahl, Bertil

AU - Horner, Daniel

PY - 2016/7

Y1 - 2016/7

N2 - STUDY OBJECTIVE: We aim to prospectively validate the diagnostic accuracy of the recently developed 0-h/1-h algorithm, using high-sensitivity cardiac troponin T (hs-cTnT) for the early rule-out and rule-in of acute myocardial infarction.METHODS: We enrolled patients presenting with suspected acute myocardial infarction and recent (<6 hours) onset of symptoms to the emergency department in a global multicenter diagnostic study. Hs-cTnT (Roche Diagnostics) and sensitive cardiac troponin I (Siemens Healthcare) were measured at presentation and after 1 hour, 2 hours, and 4 to 14 hours in a central laboratory. Patient triage according to the predefined hs-cTnT 0-hour/1-hour algorithm (hs-cTnT below 12 ng/L and Δ1 hour below 3 ng/L to rule out; hs-cTnT at least 52 ng/L or Δ1 hour at least 5 ng/L to rule in; remaining patients to the "observational zone") was compared against a centrally adjudicated final diagnosis by 2 independent cardiologists (reference standard). The final diagnosis was based on all available information, including coronary angiography and echocardiography results, follow-up data, and serial measurements of sensitive cardiac troponin I, whereas adjudicators remained blinded to hs-cTnT.RESULTS: Among 1,282 patients enrolled, acute myocardial infarction was the final diagnosis for 213 (16.6%) patients. Applying the hs-cTnT 0-hour/1-hour algorithm, 813 (63.4%) patients were classified as rule out, 184 (14.4%) were classified as rule in, and 285 (22.2%) were triaged to the observational zone. This resulted in a negative predictive value and sensitivity for acute myocardial infarction of 99.1% (95% confidence interval [CI] 98.2% to 99.7%) and 96.7% (95% CI 93.4% to 98.7%) in the rule-out zone (7 patients with false-negative results), a positive predictive value and specificity for acute myocardial infarction of 77.2% (95% CI 70.4% to 83.0%) and 96.1% (95% CI 94.7% to 97.2%) in the rule-in zone, and a prevalence of acute myocardial infarction of 22.5% in the observational zone.CONCLUSION: The hs-cTnT 0-hour/1-hour algorithm performs well for early rule-out and rule-in of acute myocardial infarction.

AB - STUDY OBJECTIVE: We aim to prospectively validate the diagnostic accuracy of the recently developed 0-h/1-h algorithm, using high-sensitivity cardiac troponin T (hs-cTnT) for the early rule-out and rule-in of acute myocardial infarction.METHODS: We enrolled patients presenting with suspected acute myocardial infarction and recent (<6 hours) onset of symptoms to the emergency department in a global multicenter diagnostic study. Hs-cTnT (Roche Diagnostics) and sensitive cardiac troponin I (Siemens Healthcare) were measured at presentation and after 1 hour, 2 hours, and 4 to 14 hours in a central laboratory. Patient triage according to the predefined hs-cTnT 0-hour/1-hour algorithm (hs-cTnT below 12 ng/L and Δ1 hour below 3 ng/L to rule out; hs-cTnT at least 52 ng/L or Δ1 hour at least 5 ng/L to rule in; remaining patients to the "observational zone") was compared against a centrally adjudicated final diagnosis by 2 independent cardiologists (reference standard). The final diagnosis was based on all available information, including coronary angiography and echocardiography results, follow-up data, and serial measurements of sensitive cardiac troponin I, whereas adjudicators remained blinded to hs-cTnT.RESULTS: Among 1,282 patients enrolled, acute myocardial infarction was the final diagnosis for 213 (16.6%) patients. Applying the hs-cTnT 0-hour/1-hour algorithm, 813 (63.4%) patients were classified as rule out, 184 (14.4%) were classified as rule in, and 285 (22.2%) were triaged to the observational zone. This resulted in a negative predictive value and sensitivity for acute myocardial infarction of 99.1% (95% confidence interval [CI] 98.2% to 99.7%) and 96.7% (95% CI 93.4% to 98.7%) in the rule-out zone (7 patients with false-negative results), a positive predictive value and specificity for acute myocardial infarction of 77.2% (95% CI 70.4% to 83.0%) and 96.1% (95% CI 94.7% to 97.2%) in the rule-in zone, and a prevalence of acute myocardial infarction of 22.5% in the observational zone.CONCLUSION: The hs-cTnT 0-hour/1-hour algorithm performs well for early rule-out and rule-in of acute myocardial infarction.

KW - Aged

KW - Aged, 80 and over

KW - Algorithms

KW - Electrocardiography

KW - Emergency Service, Hospital

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Time Factors

KW - Troponin T

KW - Journal Article

KW - Multicenter Study

UR - http://dx.doi.org/10.1016/j.annemergmed.2015.11.013

U2 - 10.1016/j.annemergmed.2015.11.013

DO - 10.1016/j.annemergmed.2015.11.013

M3 - Article

C2 - 26794254

SN - 0196-0644

VL - 68

SP - 76-87.e4

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

IS - 1

ER -

Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T

Abstract

Keywords

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Rapid diagnostic pathways reduce unnecessary hospital admissions for suspected acute coronary syndromes

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Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T

Abstract

Keywords

Access to Document

Other files and links

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Impacts

Rapid diagnostic pathways reduce unnecessary hospital admissions for suspected acute coronary syndromes

Cite this