Johannes Tobias Neumann1,2, Nils Arne Sörensen3, Francisco Ojeda3, Tjark Schwemer3, Jonas Lehmacher3, Saskia Gönner3, Nikolas Jarsetz3, Till Keller4, Sarina Schaefer3,2, Thomas Renné5, Ulf Landmesser6, Peter Clemmensen3,7, Nataliya Makarova3,2, Renate B Schnabel3,2, Tanja Zeller3,2, Mahir Karakas3,2, John W Pickering8, Martin Than8, William Parsonage9, Jaimi Greenslade9, Louise Cullen9, Dirk Westermann3,2, Stefan Blankenberg3,2. 1. Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany; j.neumann@uke.de. 2. German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany. 3. Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany. 4. Department of Cardiology, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany. 5. Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany and Clinical Chemistry, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden. 6. Department of Cardiology, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany. 7. Department of Medicine, Nykoebing F Hospital, University of Southern Denmark, Odense, Denmark. 8. Emergency Department, Christchurch Hospital, Christchurch, New Zealand. 9. Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Abstract
AIMS: Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG) to rule out AMI. METHODS: Troponin I measured with a high-sensitivity assay (hs-TnI) was determined at admission in 1040 patients presenting with suspected AMI (BACC study). To rule out AMI we calculated the negative predictive value (NPV) utilizing the optimal hs-TnI cutoff combined with a low risk ECG. The results were validated in 3566 patients with suspected AMI [2-h Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) studies]. Patients were followed for 6 or 12 months. RESULTS: 184 of all patients were diagnosed with AMI. An hs-TnI cutoff of 3 ng/L resulted in a NPV of 99.3% (CI 97.3-100.0), ruling out 35% of all non-AMI patients. Adding the information of a low risk ECG resulted in a 100% (CI 97.5-100.0) NPV (28% ruled out). The 2 validation cohorts replicated the high NPV of this approach. The follow-up mortality in the ruled out population was low (0 deaths in BACC and Stenocardia, 1 death in ADAPT). CONCLUSIONS: A single hs-TnI measurement on admission combined with a low risk ECG appears to rule out AMI safely without need for serial troponin testing. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02355457).
AIMS: Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG) to rule out AMI. METHODS: Troponin I measured with a high-sensitivity assay (hs-TnI) was determined at admission in 1040 patients presenting with suspected AMI (BACC study). To rule out AMI we calculated the negative predictive value (NPV) utilizing the optimal hs-TnI cutoff combined with a low risk ECG. The results were validated in 3566 patients with suspected AMI [2-h Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) studies]. Patients were followed for 6 or 12 months. RESULTS: 184 of all patients were diagnosed with AMI. An hs-TnI cutoff of 3 ng/L resulted in a NPV of 99.3% (CI 97.3-100.0), ruling out 35% of all non-AMI patients. Adding the information of a low risk ECG resulted in a 100% (CI 97.5-100.0) NPV (28% ruled out). The 2 validation cohorts replicated the high NPV of this approach. The follow-up mortality in the ruled out population was low (0 deaths in BACC and Stenocardia, 1 death in ADAPT). CONCLUSIONS: A single hs-TnI measurement on admission combined with a low risk ECG appears to rule out AMI safely without need for serial troponin testing. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02355457).
Authors: Dirk Westermann; Johannes Tobias Neumann; Nils Arne Sörensen; Stefan Blankenberg Journal: Nat Rev Cardiol Date: 2017-04-06 Impact factor: 32.419
Authors: Peter A Kavsak; Johannes T Neumann; Louise Cullen; Martin Than; Colleen Shortt; Jaimi H Greenslade; John W Pickering; Francisco Ojeda; Jinhui Ma; Natasha Clayton; Jonathan Sherbino; Stephen A Hill; Matthew McQueen; Dirk Westermann; Nils A Sörensen; William A Parsonage; Lauren Griffith; Shamir R Mehta; P J Devereaux; Mark Richards; Richard Troughton; Chris Pemberton; Sally Aldous; Stefan Blankenberg; Andrew Worster Journal: CMAJ Date: 2018-08-20 Impact factor: 8.262
Authors: Andrew R Chapman; Kuan Ken Lee; David A McAllister; Louise Cullen; Jaimi H Greenslade; William Parsonage; Andrew Worster; Peter A Kavsak; Stefan Blankenberg; Johannes Neumann; Nils A Sörensen; Dirk Westermann; Madelon M Buijs; Gerard J E Verdel; John W Pickering; Martin P Than; Raphael Twerenbold; Patrick Badertscher; Zaid Sabti; Christian Mueller; Atul Anand; Philip Adamson; Fiona E Strachan; Amy Ferry; Dennis Sandeman; Alasdair Gray; Richard Body; Brian Keevil; Edward Carlton; Kim Greaves; Frederick K Korley; Thomas S Metkus; Yader Sandoval; Fred S Apple; David E Newby; Anoop S V Shah; Nicholas L Mills Journal: JAMA Date: 2017-11-21 Impact factor: 56.272
Authors: Paul M Haller; Jasper Boeddinghaus; Johannes T Neumann; Nils A Sörensen; Tau S Hartikainen; Alina Goßling; Thomas Nestelberger; Raphael Twerenbold; Jonas Lehmacher; Till Keller; Tanja Zeller; Stefan Blankenberg; Christian Mueller; Dirk Westermann Journal: Diabetes Care Date: 2019-12-16 Impact factor: 17.152
Authors: Johannes Tobias Neumann; Nils Arne Sörensen; Francisco Ojeda; Thomas Renné; Renate B Schnabel; Tanja Zeller; Mahir Karakas; Stefan Blankenberg; Dirk Westermann Journal: PLoS One Date: 2017-03-23 Impact factor: 3.240
Authors: Anoop S V Shah; Atul Anand; Fiona E Strachan; Amy V Ferry; Kuan Ken Lee; Andrew R Chapman; Dennis Sandeman; Catherine L Stables; Philip D Adamson; Jack P M Andrews; Mohamed S Anwar; John Hung; Alistair J Moss; Rachel O'Brien; Colin Berry; Iain Findlay; Simon Walker; Anne Cruickshank; Alan Reid; Alasdair Gray; Paul O Collinson; Fred S Apple; David A McAllister; Donogh Maguire; Keith A A Fox; David E Newby; Christopher Tuck; Ronald Harkess; Richard A Parker; Catriona Keerie; Christopher J Weir; Nicholas L Mills Journal: Lancet Date: 2018-08-28 Impact factor: 79.321
Authors: Eve Miller-Hodges; Atul Anand; Anoop S V Shah; Andrew R Chapman; Peter Gallacher; Kuan Ken Lee; Tariq Farrah; Nynke Halbesma; James P Blackmur; David E Newby; Nicholas L Mills; Neeraj Dhaun Journal: Circulation Date: 2017-10-04 Impact factor: 29.690