Document Detail

Two hour algorithm for triage towards rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac Troponin T.
MedLine Citation:
PMID:  25446294     Owner:  NLM     Status:  Publisher    
BACKGROUND: High-sensitivity cardiac troponin (hs-cTn) may allow an earlier diagnosis of acute myocardial infarction (AMI).
METHODS: We prospectively enrolled 1148 (derivation cohort) and 517 (external validation cohort) unselected patients presenting with suspected AMI to the emergency department. Final diagnosis was adjudicated by two independent cardiologists. Hs-cTnT was measured at presentation and after two hours. A diagnostic algorithm incorporating hs-cTnT values at presentation and absolute changes within the first two hours was derived.
RESULTS: AMI was the final diagnosis in 16% of patients in the derivation and 9.1% in the validation cohort. The 2h algorithm developed in the derivation cohort classified 60% of patients as "rule-out", 16% as "rule-in" and 24% in the "observational- zone". Resulting sensitivity and negative predictive value (NPV) were 99.5% and 99.9% for rule-out, and specificity and positive predictive value (PPV) 96% and 78% for rule-in. Applying the 2h triage algorithm in the external validation cohort, 78% of patients could be classified as "rule-out", 8% as "rule-in" and 14% in the "observational-zone". Resulting sensitivity and NPV were 96% and 99.5% for rule-out and specificity and PPV 99% and 85% for rule-in. Cumulative 30-day survival rates were 100%, 98.9% and 95.2% (p<0.001) and 100%,100% and 95% (p<0.001) in patients classified as "rule-out", "observational-zone" and "rule-in" in the two cohorts respectively.
CONCLUSIONS: A simple algorithm incorporating hs-cTnT baseline values and absolute changes over two hours allowed a triage towards safe rule-out, or accurate rule-in, of AMI in the vast majority of patients with only 20% requiring more prolonged monitoring and serial blood sampling.
Tobias Reichlin; Louise Cullen; William A Parsonage; Jaimi Greenslade; Raphael Twerenbold; Berit Moehring; Karin Wildi; Sandra Mueller; Christa Zellweger; Tamina Mosimann; Maria Rubini-Giménez; Katharina Rentsch; Stefan Osswald; Christian Mueller
Related Documents :
12189044 - Catecholamine effects on cardiac remodelling, oxidative stress and fibrosis in experime...
20484854 - Anti-inflammatory effect of guan-xin-er-hao via the nuclear factor-kappa b signaling pa...
6867474 - Experimental right-ventricular infarction in rats by abdominodiaphragmal access to the ...
1534434 - Effect of cilazapril on regional left ventricular wall thickness and chamber dimension ...
17521304 - Reduction of dispersion of repolarization and prolongation of postrepolarization refrac...
18804744 - Prevalence of different gadolinium enhancement patterns in patients after heart transpl...
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-13
Journal Detail:
Title:  The American journal of medicine     Volume:  -     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-12-2     Completed Date:  -     Revised Date:  2014-12-3    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Elsevier Inc. All rights reserved.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Guinea pig models of asthma.
Next Document:  Steroid Exposure, Acute Coronary Syndrome, and Inflammatory Bowel Disease: Insights into the Inflamm...