Publication details

Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction

Authors	TWERENBOLD R. NEUMANN J.T. SORENSEN N.A. OJEDA F. KARAKAS M. BOEDDINGHAUS J. NESTELBERGER T. BADERTSCHER P. GIMEENEZ M.R. PUELACHER C. WILDI K. KOZHUHAROV N. BREITENBUECHER D. BISKUP E. LAVALLAZ J.D. de FLORES D. WUSSLER D. MIRO O. SANCHEZ F.J.M. MORAWIEC B. PAŘENICA Jiří GEIGY N. KELLER D.I. ZELLER T. REICHLIN T. BLANKENBERG S. WESTERMANN D. MUELLER C.
Year of publication	2018
Type	Article in Periodical
Magazine / Source	Journal of the American College of Cardiology
MU Faculty or unit	Faculty of Medicine
Citation
Doi	http://dx.doi.org/10.1016/j.jacc.2018.05.040
Keywords	diagnosis of myocardial infarction; diagnostic algorithms; myocardial infarction; rule-in; rule-out; troponin
Description	BACKGROUND The safety of the European Society of Cardiology (ESC) 0/1-h algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin (hs-cTn) has been questioned. OBJECTIVES This study aimed to validate the diagnostic performance of the 0/1-h algorithm in a large multicenter study. METHODS The authors prospectively enrolled unsetected patients in 6 countries presenting to the emergency department with symptoms suggestive of NSTEMI. Final diagnosis was centrally adjudicated by 2 independent cardiologists. Hs-cTnT and hs-cTnI blood concentrations were measured at presentation and after 1 h. Safety of rule-out was quantified by the negative predictive value (NPV) for NSTEMI, accuracy of rule-in by the positive predictive value (PPV), and overall efficacy by the proportion of patients triaged towards rule-out or rule-in within 1 h. RESULTS Prevalence of NSTEMI was 17%. Among 4,368 patients with serial hs-cTnT measurements available, safety of rule-out (NPV 99.8%, 2,488 of 2,493), accuracy of rule-in (PPV 74.5%, 572 of 768), and overall efficacy were high by assigning three-fourths of patients either to rule-out (57%, 2,493 to 4,368) or rule-in (18%, 768 to 4,368). Similarly, among 3,500 patients with serial hs-cTnI measurements, safety of rule-out (NPV 99.7%, 1,528 of 1,533), accuracy of rule-in (PPV 62.3%, 498 of 800), and overall efficacy were high by assigning more than two-thirds of patients either to rule-out (44%, 1,533 of 3,500) or rule-in (23%, 800 of 3,500). Excellent safety was confirmed in multiple subgroup analyses including patients presenting early h) after chest pain onset. CONCLUSIONS The ESC 0/1-h algorithm using hs-cTnT and hs-cTnI is very safe and effective in triaging patients with suspected NSTEMI. (C) 2018 by the American College of Cardiology Foundation.