| Related Articles |
Early rule-out and rule-in of myocardial infarction using sensitive cardiac Troponin I.
Int J Cardiol. 2015 May 15;195:163-170
Authors: Druey S, Wildi K, Twerenbold R, Jaeger C, Reichlin T, Haaf P, Rubini Gimenez M, Puelacher C, Wagener M, Radosavac M, Honegger U, Schumacher C, Delfine V, Kreutzinger P, Herrmann T, Moreno Weidmann Z, Krivoshei L, Freese M, Stelzig C, Isenschmid C, Bassetti S, Rentsch K, Osswald S, Mueller C
Abstract
BACKGROUND: It is currently unknown, whether and to what extent sensitive cardiac troponin (s-cTn) allows shortening of the time required for safe rule-out and rule-in of acute myocardial infarction (AMI).
METHODS: We aimed to develop and validate early rule-out and rule-in algorithms for AMI using a thoroughly-examined and commonly used s-cTnI assay in a prospective multicenter study including 2173 patients presenting to the emergency department with suspected AMI. S-cTnI was measured in a blinded fashion at 0h, 1h, and 2h. The final diagnosis was centrally adjudicated by two independent cardiologists. In the derivation cohort (n=1496), we developed 1h- and 2h-algorithms assigning patients to "rule-out", "rule-in", or "observe". The algorithms were then prospectively validated in the validation cohort (n=677).
RESULTS: AMI was the adjudicated diagnosis in 17% of patients. After applying the s-cTnI 1h-algorithm developed in the derivation cohort to the validation cohort, 65% of patients were classified as "rule-out", 12% as "rule-in", and 23% to "observe". The negative predictive value for AMI in the "rule-out" group was 98.6% (95% CI, 96.9-99.5), the positive predictive value for AMI in the "rule-in" group 76.3% (95% CI, 65.4-85.1). Overall, 30-day mortality was 0.2% in the "rule-out" group, 1.0% in the "observe" group, and 3.0% in the "rule-in" group. Similar results were obtained for the 2h-algorithm.
CONCLUSION: When used in conjunction with other clinical information including the ECG, a simple algorithm incorporating s-cTnI values at presentation and after 1h (or 2h) will allow safe rule-out and accurate rule-in of AMI in the majority of patients.
PMID: 26043151 [PubMed - as supplied by publisher]