Jasper Boeddinghaus1, Tobias Reichlin2, Louise Cullen3, Jaimi H Greenslade3, William A Parsonage4, Christopher Hammett5, John W Pickering6, Tracey Hawkins3, Sally Aldous7, Raphael Twerenbold2, Karin Wildi8, Thomas Nestelberger1, Karin Grimm1, Maria Rubini-Gimenez2, Christian Puelacher8, Vera Kern8, Katharina Rentsch9, Martin Than7, Christian Mueller10. 1. Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, and Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; 2. Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, and. 3. Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Public Health, The Queensland University of Technology, Brisbane, Australia; 4. School of Public Health, The Queensland University of Technology, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia; 5. School of Medicine, The University of Queensland, Brisbane, Australia; 6. Department of Medicine, University of Otago, Christchurch, New Zealand; Emergency Department, Christchurch Hospital, Christchurch, New Zealand; 7. Emergency Department, Christchurch Hospital, Christchurch, New Zealand; 8. Cardiovascular Research Institute Basel (CRIB). 9. Laboratory Medicine, University Hospital Basel, Basel, Switzerland. 10. Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, and christian.mueller@usb.ch.
Abstract
BACKGROUND: The early triage of patients toward rule-out and rule-in of acute myocardial infarction (AMI) is challenging. Therefore, we aimed to develop a 2-h algorithm that uses high-sensitivity cardiac troponin I (hs-cTnI). METHODS: We prospectively enrolled 1435 (derivation cohort) and 1194 (external validation cohort) patients presenting with suspected AMI to the emergency department. The final diagnosis was adjudicated by 2 independent cardiologists. hs-cTnI was measured at presentation and after 2 h in a blinded fashion. We derived and validated a diagnostic algorithm incorporating hs-cTnI values at presentation and absolute changes within the first 2 h. RESULTS: AMI was the final diagnosis in 17% of patients in the derivation and 13% in the validation cohort. The 2-h algorithm developed in the derivation cohort classified 56% of patients as rule-out, 17% as rule-in, and 27% as observation. Resulting diagnostic sensitivity and negative predictive value (NPV) were 99.2% and 99.8% for rule-out; specificity and positive predictive value (PPV) were 95.2% and 75.8% for rule-in. Applying the 2-h algorithm in the external validation cohort, 60% of patients were classified as rule-out, 13% as rule-in, and 27% as observation. Diagnostic sensitivity and NPV were 98.7% and 99.7% for rule-out; specificity and PPV were 97.4% and 82.2% for rule-in. Thirty-day survival was 100% for rule-out patients in both cohorts. CONCLUSIONS: A simple algorithm incorporating hs-cTnI baseline values and absolute 2-h changes allowed a triage toward safe rule-out or accurate rule-in of AMI in the majority of patients.
BACKGROUND: The early triage of patients toward rule-out and rule-in of acute myocardial infarction (AMI) is challenging. Therefore, we aimed to develop a 2-h algorithm that uses high-sensitivity cardiac troponin I (hs-cTnI). METHODS: We prospectively enrolled 1435 (derivation cohort) and 1194 (external validation cohort) patients presenting with suspected AMI to the emergency department. The final diagnosis was adjudicated by 2 independent cardiologists. hs-cTnI was measured at presentation and after 2 h in a blinded fashion. We derived and validated a diagnostic algorithm incorporating hs-cTnI values at presentation and absolute changes within the first 2 h. RESULTS: AMI was the final diagnosis in 17% of patients in the derivation and 13% in the validation cohort. The 2-h algorithm developed in the derivation cohort classified 56% of patients as rule-out, 17% as rule-in, and 27% as observation. Resulting diagnostic sensitivity and negative predictive value (NPV) were 99.2% and 99.8% for rule-out; specificity and positive predictive value (PPV) were 95.2% and 75.8% for rule-in. Applying the 2-h algorithm in the external validation cohort, 60% of patients were classified as rule-out, 13% as rule-in, and 27% as observation. Diagnostic sensitivity and NPV were 98.7% and 99.7% for rule-out; specificity and PPV were 97.4% and 82.2% for rule-in. Thirty-day survival was 100% for rule-out patients in both cohorts. CONCLUSIONS: A simple algorithm incorporating hs-cTnI baseline values and absolute 2-h changes allowed a triage toward safe rule-out or accurate rule-in of AMI in the majority of patients.
Authors: Jasper Boeddinghaus; Tobias Reichlin; Thomas Nestelberger; Raphael Twerenbold; Yvette Meili; Karin Wildi; Petra Hillinger; Maria Rubini Giménez; Janosch Cupa; Lukas Schumacher; Marie Schubera; Patrick Badertscher; Sydney Corbière; Karin Grimm; Christian Puelacher; Zaid Sabti; Dayana Flores Widmer; Nicolas Schaerli; Nikola Kozhuharov; Samyut Shrestha; Tobias Bürge; Patrick Mächler; Michael Büchi; Katharina Rentsch; Òscar Miró; Beatriz López; F Javier Martin-Sanchez; Esther Rodriguez-Adrada; Beata Morawiec; Damian Kawecki; Eva Ganovská; Jiri Parenica; Jens Lohrmann; Andreas Buser; Dagmar I Keller; Stefan Osswald; Christian Mueller Journal: Clin Res Cardiol Date: 2017-02-01 Impact factor: 5.460
Authors: Dirk Westermann; Johannes Tobias Neumann; Nils Arne Sörensen; Stefan Blankenberg Journal: Nat Rev Cardiol Date: 2017-04-06 Impact factor: 32.419
Authors: Ivo Strebel; Raphael Twerenbold; Jasper Boeddinghaus; Roger Abächerli; Maria Rubini Giménez; Karin Wildi; Karin Grimm; Christian Puelacher; Patrick Badertscher; Zaid Sabti; Dominik Breitenbücher; Janina Jann; Farah Selman; Jeanne du Fay de Lavallaz; Nicolas Schaerli; Thomas Nestelberger; Claudia Stelzig; Michael Freese; Lukas Schumacher; Stefan Osswald; Christian Mueller; Tobias Reichlin Journal: Ann Noninvasive Electrocardiol Date: 2018-02-24 Impact factor: 1.468
Authors: Matthew T H Lowry; Dimitrios Doudesis; Ryan Wereski; Dorien M Kimenai; Christopher Tuck; Amy V Ferry; Anda Bularga; Caelan Taggart; Kuan K Lee; Andrew R Chapman; Anoop S V Shah; David E Newby; Nicholas L Mills; Atul Anand Journal: Circulation Date: 2022-09-15 Impact factor: 39.918
Authors: Júlia Karády; Thomas Mayrhofer; Maros Ferencik; John T Nagurney; James E Udelson; Andreas A Kammerlander; Jerome L Fleg; W Frank Peacock; James L Januzzi; Wolfgang Koenig; Udo Hoffmann Journal: J Am Coll Cardiol Date: 2021-03-30 Impact factor: 24.094
Authors: Thomas E Kaier; Raphael Twerenbold; Christian Puelacher; Jack Marjot; Nazia Imambaccus; Jasper Boeddinghaus; Thomas Nestelberger; Patrick Badertscher; Zaid Sabti; Maria Rubini Giménez; Karin Wildi; Petra Hillinger; Karin Grimm; Sarah Loeffel; Samyut Shrestha; Dayana Flores Widmer; Janosch Cupa; Nikola Kozhuharov; Òscar Miró; F Javier Martín-Sánchez; Beata Morawiec; Katharina Rentsch; Jens Lohrmann; Wanda Kloos; Stefan Osswald; Tobias Reichlin; Ekkehard Weber; Michael Marber; Christian Mueller Journal: Circulation Date: 2017-09-26 Impact factor: 29.690