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Lehmacher, Jonas; Toprak, Betül; Sörensen, Nils Arne; Bei der Kellen, Ramona; Goßling, Alina; Hartikainen, Tau Sarra; Haller, Paul Michael; Schock, Alina; Twerenbold, Raphael; Zeller, Tanja; Blankenberg, Stefan; Westermann, Dirk; Neumann, Johannes Tobias

Validation of a 0/1 h Algorithm for Rapid Diagnosis of Myocardial Infarction Using a High-Sensitivity Troponin I Assay

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  • Medientyp: E-Artikel
  • Titel: Validation of a 0/1 h Algorithm for Rapid Diagnosis of Myocardial Infarction Using a High-Sensitivity Troponin I Assay
  • Beteiligte: Lehmacher, Jonas; Toprak, Betül; Sörensen, Nils Arne; Bei der Kellen, Ramona; Goßling, Alina; Hartikainen, Tau Sarra; Haller, Paul Michael; Schock, Alina; Twerenbold, Raphael; Zeller, Tanja; Blankenberg, Stefan; Westermann, Dirk; Neumann, Johannes Tobias
  • Erschienen: Oxford University Press (OUP), 2023
  • Erschienen in: Clinical Chemistry, 69 (2023) 5, Seite 482-491
  • Sprache: Englisch
  • DOI: 10.1093/clinchem/hvad019
  • ISSN: 0009-9147; 1530-8561
  • Schlagwörter: Biochemistry (medical) ; Clinical Biochemistry
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Current guidelines recommend 0/1 h algorithms using high-sensitivity cardiac troponin (hs-cTn) for fast diagnosis of myocardial infarction (MI). Yet, for some assays, existing data is limited. We aimed to evaluate the diagnostic performance and the prognostic value of a rapid 0/1 h algorithm for the Access hs-cTnI assay.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>In consecutive patients presenting with suspected MI, we measured concentrations of Access hs-cTnI at presentation and after 1 hour. Final diagnosis was adjudicated independently by 2 cardiologists. Parameters for diagnostic performance were calculated, applying the recently derived European Society of Cardiology (ESC) 0/1 h algorithm for Access hs-cTnI. Additionally, we assessed the prognostic utility of Access hs-cTnI for the composite end point of all-cause mortality and incident MI at 3 years.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In 1879 patients, 257 non-ST-elevation MIs occurred. Application of the 0/1 h algorithm classified 44.5% as rule-out, 20.3% as rule-in, and triaged 35.1% to the observe group. High rule-out safety was confirmed with a sensitivity of 97.7% (95% CI, 95.0%–99.1%) and a negative predictive value of 99.3% (95% CI, 98.4%–99.7%). Rule-in capacity was moderate with a specificity of 88.0% (95% CI, 86.3%–89.6%) and a positive predictive value of 50.8% (95% CI, 45.7%–55.9%). After exclusion of patients with ST-elevation MI the results showed strong prognostic value, even after adjustment for cardiovascular risk factors and comorbidities, with adjusted hazard ratios of 2.51 (95% CI, 1.56–4.04) in the observe and 3.55 (95% CI, 2.18–5.79) in the rule-in group for the composite end point of all-cause mortality and incident MI at 3 years, compared to ruled-out patients.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>The ESC 0/1 h algorithm for Access hs-cTnI allows safe and efficient triage of patients with suspected MI and has strong prognostic utility up to 3 years after the initial evaluation.</jats:p> </jats:sec>