Johannes Tobias Neumann1, Nils Arne Sörensen2, Tjark Schwemer2, Francisco Ojeda2, Rafael Bourry2, Vanessa Sciacca2, Sarina Schaefer1, Christoph Waldeyer2, Christoph Sinning2, Thomas Renné3, Martin Than4, William Parsonage5, Karin Wildi6, Nataliya Makarova1, Renate B Schnabel1, Ulf Landmesser7, Christian Mueller6, Louise Cullen5, Jaimi Greenslade5, Tanja Zeller1, Stefan Blankenberg1, Mahir Karakas1, Dirk Westermann1. 1. Department of General and Interventional Cardiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany2German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany. 2. Department of General and Interventional Cardiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 3. Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany4Unit of Clinical Chemistry, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden. 4. Emergency Department, Christchurch Hospital, Christchurch, New Zealand. 5. Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia. 6. Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland. 7. Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
Abstract
IMPORTANCE: Rapid and accurate diagnosis of acute myocardial infarction (AMI) currently constitutes an unmet need. OBJECTIVE: To test a 1-hour diagnostic algorithm to diagnose AMI using a high-sensitivity troponin I assay with a new cutoff level of 6 ng/L. DESIGN, SETTING, AND PARTICIPANTS: The Biomarkers in Acute Cardiac Care study is a prospective study that investigated the application of the troponin I assay for the diagnosis of AMI in 1040 patients presenting to the emergency department with acute chest pain from July 19, 2013, to December 31, 2014. Results were validated in 2 independent cohorts of 4009 patients. Final follow-up was completed on July 1, 2015, and data were assessed from July 2 to December 15, 2015. EXPOSURE: Acute chest pain suggestive of AMI. MAIN OUTCOMES AND MEASURES: Accurate diagnosis or exclusion of AMI and 12-month mortality in patients with acute chest pain. RESULTS: Of the 1040 patients included from the study cohort, 673 (64.7%) were male and had a median age of 65 (interquartile range, 52-75) years. With application of a low troponin I cutoff value of 6 ng/L, the rule-out algorithm showed a high negative predictive value of 99.8% (95% CI, 98.6%-100.0%) after 1 hour for non-ST-segment elevation MI type 1. The 1-hour approach was comparable to a 3-hour approach. Similarly, a rule-in algorithm based on troponin I levels provided a high positive predictive value with 82.8% (95% CI, 73.2%-90.0%). Moreover, application of the cutoff of 6 ng/L resulted in lower follow-up mortality (1.0%) compared with the routinely used 99th percentile (3.7%) for this assay. Two independent cohorts further validated the performance of this algorithm with high negative and positive predictive values. CONCLUSIONS AND RELEVANCE: Patients with possible AMI can be triaged within 1 hour after admission with no loss of safety compared with a 3-hour approach, when a low and sensitive cutoff is applied. This concept enables safe discharge or rapid treatment initiation after 1 hour.
IMPORTANCE: Rapid and accurate diagnosis of acute myocardial infarction (AMI) currently constitutes an unmet need. OBJECTIVE: To test a 1-hour diagnostic algorithm to diagnose AMI using a high-sensitivity troponin I assay with a new cutoff level of 6 ng/L. DESIGN, SETTING, AND PARTICIPANTS: The Biomarkers in Acute Cardiac Care study is a prospective study that investigated the application of the troponin I assay for the diagnosis of AMI in 1040 patients presenting to the emergency department with acute chest pain from July 19, 2013, to December 31, 2014. Results were validated in 2 independent cohorts of 4009 patients. Final follow-up was completed on July 1, 2015, and data were assessed from July 2 to December 15, 2015. EXPOSURE: Acute chest pain suggestive of AMI. MAIN OUTCOMES AND MEASURES: Accurate diagnosis or exclusion of AMI and 12-month mortality in patients with acute chest pain. RESULTS: Of the 1040 patients included from the study cohort, 673 (64.7%) were male and had a median age of 65 (interquartile range, 52-75) years. With application of a low troponin I cutoff value of 6 ng/L, the rule-out algorithm showed a high negative predictive value of 99.8% (95% CI, 98.6%-100.0%) after 1 hour for non-ST-segment elevation MI type 1. The 1-hour approach was comparable to a 3-hour approach. Similarly, a rule-in algorithm based on troponin I levels provided a high positive predictive value with 82.8% (95% CI, 73.2%-90.0%). Moreover, application of the cutoff of 6 ng/L resulted in lower follow-up mortality (1.0%) compared with the routinely used 99th percentile (3.7%) for this assay. Two independent cohorts further validated the performance of this algorithm with high negative and positive predictive values. CONCLUSIONS AND RELEVANCE: Patients with possible AMI can be triaged within 1 hour after admission with no loss of safety compared with a 3-hour approach, when a low and sensitive cutoff is applied. This concept enables safe discharge or rapid treatment initiation after 1 hour.
Authors: Simon A Mahler; Jason P Stopyra; Fred S Apple; Robert F Riley; Gregory B Russell; Brian C Hiestand; James W Hoekstra; Cedric W Lefebvre; Bret A Nicks; David M Cline; Kim L Askew; David M Herrington; Gregory L Burke; Chadwick D Miller Journal: Clin Biochem Date: 2017-01-10 Impact factor: 3.281
Authors: Dirk Westermann; Johannes Tobias Neumann; Nils Arne Sörensen; Stefan Blankenberg Journal: Nat Rev Cardiol Date: 2017-04-06 Impact factor: 32.419
Authors: Flavia Ribeiro Machado; Murillo Santucci Cesar de Assunção; Alexandre Biasi Cavalcanti; André Miguel Japiassú; Luciano Cesar Pontes de Azevedo; Mirella Cristine Oliveira Journal: Rev Bras Ter Intensiva Date: 2016 Oct-Dec
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