Two-hour algorithm for triage toward rule-out and rule-in of acute myocardial infarction by use of high-sensitivity cardiac troponin I

Boeddinghaus, Jasper, Reichlin, Tobias, Cullen, Louise, Greenslade, Jaimi H., Parsonage, William A., Hammett, Christopher, Pickering, John W., Hawkins, Tracey, Aldous, Sally, Twerenbold, Raphael, Wildi, Karin, Nestelberger, Thomas, Grimm, Karin, Rubini-Gimenez, Maria, Puelacher, Christian, Kern, Vera, Rentsch, Katharina, Than, Martin and Mueller, Christian (2016) Two-hour algorithm for triage toward rule-out and rule-in of acute myocardial infarction by use of high-sensitivity cardiac troponin I. Clinical Chemistry, 62 3: 494-504. doi:10.1373/clinchem.2015.249508


Author Boeddinghaus, Jasper
Reichlin, Tobias
Cullen, Louise
Greenslade, Jaimi H.
Parsonage, William A.
Hammett, Christopher
Pickering, John W.
Hawkins, Tracey
Aldous, Sally
Twerenbold, Raphael
Wildi, Karin
Nestelberger, Thomas
Grimm, Karin
Rubini-Gimenez, Maria
Puelacher, Christian
Kern, Vera
Rentsch, Katharina
Than, Martin
Mueller, Christian
Title Two-hour algorithm for triage toward rule-out and rule-in of acute myocardial infarction by use of high-sensitivity cardiac troponin I
Journal name Clinical Chemistry   Check publisher's open access policy
ISSN 1530-8561
0009-9147
Publication date 2016-03-01
Sub-type Article (original research)
DOI 10.1373/clinchem.2015.249508
Open Access Status Not yet assessed
Volume 62
Issue 3
Start page 494
End page 504
Total pages 11
Place of publication Washington, DC, United States
Publisher American Association for Clinical Chemistry
Language eng
Formatted 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.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Fri, 20 Apr 2018, 02:18:46 EST