Bernadette Meller1, Louise Cullen2, William A Parsonage3, Jaimi H Greenslade2, Sally Aldous4, Tobias Reichlin5, Karin Wildi1, Raphael Twerenbold1, Cedric Jaeger1, Petra Hillinger1, Philip Haaf1, Christian Puelacher1, Vera Kern1, Katharina Rentsch6, Fabio Stallone1, Maria Rubini Gimenez7, Paola Ballarino8, Stefano Bassetti9, Astrid Walukiewicz1, Richard Troughton10, Christopher J Pemberton10, A Mark Richards10, Kevin Chu11, Christopher M Reid11, Martin Than4, Christian Mueller12. 1. Department of Cardiology, University Hospital, Basel, Switzerland. 2. Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. 3. Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. 4. Christchurch Hospital, Christchurch, New Zealand. 5. Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 6. Department of Laboratory Medicine, University Hospital, Basel, Switzerland. 7. Department of Cardiology, University Hospital, Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar, Institut Municipal d'Investigació Mèdica, Barcelona, Spain. 8. Emergency Department, San Martino University Hospital, Genoa, Italy. 9. Kantonsspital Olten, Switzerland. 10. Christchurch Heart Institute, University of Otago, Christchurch, New Zealand. 11. CCRE Therapeutics, Monash University, Australia. 12. Department of Cardiology, University Hospital, Basel, Switzerland. Electronic address: christian.mueller@usbs.ch.
Abstract
BACKGROUND: We aimed to evaluate the efficacy and safety of using high-sensitivity cardiac troponin T (hs-cTnT) within an accelerated diagnostic protocol (ADP) in patients presenting with symptoms suggestive of acute myocardial infarction (AMI) for rapid rule-out of AMI. METHODS: In two independent large multicenter studies, levels of hs-cTnT at presentation and at 2 h were combined with the Thrombolysis In Myocardial Infarction (TIMI) risk score and ECG findings. The ADP defined patients with normal levels of hs-cTnT at presentation and 2 h, a TIMI score ≤1, and normal ECG findings as candidates for rapid rule-out of AMI and rapid discharge. Major adverse cardiac events (MACEs) occurring within 30-days were centrally adjudicated by two independent cardiologists. RESULTS: In the derivation cohort, among 1085 consecutive patients 198 patients (18.2%) had a MACE. The ADP classified 374 patients (34.5%) as low-risk. None of these patients had a MACE at 30 days, resulting in a negative predictive value (NPV) of 100% (95% CI, 99.0-100%) and a sensitivity of 100% (95% CI, 98.2%-100%). In the validation cohort, among 1590 consecutive patients 231 patients (14.5%) had a MACE. The ADP classified 641 patients (40.3%) as low-risk. 6 of these patients had a MACE at 30 days, resulting in a NPV of 99.1% (95% CI, 98.0-99.6%) and a sensitivity of 97.4% (95% CI, 94.5-98.8%). CONCLUSIONS: The ADP including hs-cTnT allows early identification 35 to 40% of patients to be at extremely low risk of MACE and therefore ideal candidates for outpatient management.
BACKGROUND: We aimed to evaluate the efficacy and safety of using high-sensitivity cardiac troponin T (hs-cTnT) within an accelerated diagnostic protocol (ADP) in patients presenting with symptoms suggestive of acute myocardial infarction (AMI) for rapid rule-out of AMI. METHODS: In two independent large multicenter studies, levels of hs-cTnT at presentation and at 2 h were combined with the Thrombolysis In Myocardial Infarction (TIMI) risk score and ECG findings. The ADP defined patients with normal levels of hs-cTnT at presentation and 2 h, a TIMI score ≤1, and normal ECG findings as candidates for rapid rule-out of AMI and rapid discharge. Major adverse cardiac events (MACEs) occurring within 30-days were centrally adjudicated by two independent cardiologists. RESULTS: In the derivation cohort, among 1085 consecutive patients 198 patients (18.2%) had a MACE. The ADP classified 374 patients (34.5%) as low-risk. None of these patients had a MACE at 30 days, resulting in a negative predictive value (NPV) of 100% (95% CI, 99.0-100%) and a sensitivity of 100% (95% CI, 98.2%-100%). In the validation cohort, among 1590 consecutive patients 231 patients (14.5%) had a MACE. The ADP classified 641 patients (40.3%) as low-risk. 6 of these patients had a MACE at 30 days, resulting in a NPV of 99.1% (95% CI, 98.0-99.6%) and a sensitivity of 97.4% (95% CI, 94.5-98.8%). CONCLUSIONS: The ADP including hs-cTnT allows early identification 35 to 40% of patients to be at extremely low risk of MACE and therefore ideal candidates for outpatient management.
Authors: Maros Ferencik; Thomas Mayrhofer; Michael T Lu; Pamela K Woodard; Quynh A Truong; W Frank Peacock; Fabian Bamberg; Benjamin C Sun; Jerome L Fleg; John T Nagurney; James E Udelson; Wolfgang Koenig; James L Januzzi; Udo Hoffmann Journal: Clin Chem Date: 2017-09-18 Impact factor: 8.327
Authors: Dieter Fischer; Friederike Remberg; Dirk Böse; Michael Lichtenberg; Philipp Kümpers; Pia Lebiedz; Hermann-Joseph Pavenstädt; Johannes Waltenberger; Frank Breuckmann Journal: Eur J Med Res Date: 2016-03-17 Impact factor: 2.175
Authors: Jungchan Park; Seung-Hwa Lee; Jeong Jin Min; Jong-Hwan Lee; Ji Hye Kwon; Ja Eun Lee; Jin-Ho Choi; Young Tak Lee; Wook Sung Kim; Myungsoo Park; Ji Su Jang; Sangmin Maria Lee Journal: Sci Rep Date: 2019-11-15 Impact factor: 4.379