Informace o publikaci

0/1-Hour Triage Algorithm for Myocardial Infarction in Patients With Renal Dysfunction

Autoři	TWERENBOLD R. BADERTSCHER P. BOEDDINGHAUS J. NESTELBERGER T. WILDI K. PUELACHER C. SABTI Z. GIMENEZ M.R. TSCHIRKY S. LAVALLAZ J.D. de KOZHUHAROV N. SAZGARY L. MUELLER D. BREIDTHARDT T. STREBEL I. WIDMER D.F. SHRESTHA S. MIRO O. MARTIN-SANCHEZ F.J. MORAWIEC B. PAŘENICA Jiří GEIGY N. KELLER D.I. RENTSCH K. ECKARDSTEIN A. von OSSWALD S. REICHLIN T. MUELLER C.
Rok publikování	2018
Druh	Článek v odborném periodiku
Časopis / Zdroj	Circulation
Fakulta / Pracoviště MU	Lékařská fakulta
Citace
Doi	http://dx.doi.org/10.1161/CIRCULATIONAHA.117.028901
Klíčová slova	0/1-hour algorithm; chronic kidney disease; diagnosis of acute myocardial infarction; high-sensitivity cardiac troponin; renal dysfunction
Popis	Background: The European Society of Cardiology recommends a 0/1-hour algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction using high-sensitivity cardiac troponin (hs-cTn) concentrations irrespective of renal function. Because patients with renal dysfunction (RD) frequently present with increased hs-cTn concentrations even in the absence of non-ST-segment elevation myocardial infarction, concern has been raised regarding the performance of the 0/1-hour algorithm in RD. Methods: In a prospective multicenter diagnostic study enrolling unselected patients presenting with suspected non-ST-segment elevation myocardial infarction to the emergency department, we assessed the diagnostic performance of the European Society of Cardiology 0/1-hour algorithm using hs-cTnT and hs-cTnI in patients with RD, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2), and compared it to patients with normal renal function. The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including cardiac imaging. Safety was quantified as sensitivity in the rule-out zone, accuracy as the specificity in the rule-in zone, and efficacy as the proportion of the overall cohort assigned to either rule-out or rule-in based on the 0- and 1-hour sample. Results: Among 3254 patients, RD was present in 487 patients (15%). The prevalence of non-ST-segment elevation myocardial infarction was substantially higher in patients with RD compared with patients with normal renal function (31% versus 13%, P<0.001). Using hs-cTnT, patients with RD had comparable sensitivity of rule-out (100.0% [95% confidence interval {CI}, 97.6-100.0] versus 99.2% [95% CI, 97.6-99.8]; P=0.559), lower specificity of rule-in (88.7% [95% CI, 84.8-91.9] versus 96.5% [95% CI, 95.7-97.2]; P<0.001), and lower overall efficacy (51% versus 81%, P<0.001), mainly driven by a much lower percentage of patients eligible for rule-out (18% versus 68%, P<0.001) compared with patients with normal renal function. Using hs-cTnI, patients with RD had comparable sensitivity of rule-out (98.6% [95% CI, 95.0-99.8] versus 98.5% [95% CI, 96.5-99.5]; P=1.0), lower specificity of rule-in (84.4% [95% CI, 79.9-88.3] versus 91.7% [95% CI, 90.5-92.9]; P<0.001), and lower overall efficacy (54% versus 76%, P<0.001; proportion ruled out, 18% versus 58%, P<0.001) compared with patients with normal renal function. Conclusions: In patients with RD, the safety of the European Society of Cardiology 0/1-hour algorithm is high, but specificity of rule-in and overall efficacy are decreased. Modifications of the rule-in and rule-out thresholds did not improve the safety or overall efficacy of the 0/1-hour algorithm. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00470587.