Comparison of fourteen rule-out strategies for acute myocardial infarction

被引：51

作者：

Wildi, Karin ^{[1
,2
,4
,15
]}

Boeddinghaus, Jasper ^{[1
,2
,4
,16
]}

Nestelberger, Thomas ^{[1
,2
,4
,16
]}

Twerenbold, Raphael ^{[1
,2
,4
,17
]}

Badertscher, Patrick ^{[1
,2
,4
]}

Wussler, Desiree ^{[1
,2
,4
,16
]}

Gimenez, Maria Rubini ^{[1
,2
,4
]}

Puelacher, Christian ^{[1
,2
,4
,16
]}

de Lavallaz, Jeanne du Fay ^{[1
,2
,4
,16
]}

Dietsche, Sebastian ^{[1
,2
,4
]}

Walter, Joan ^{[1
,2
,4
,16
]}

Kozhuharov, Nikola ^{[1
,2
,4
,16
]}

Morawiec, Beata ^{[4
,7
]}

Miro, Oscar ^{[4
,5
]}

Javier Martin-Sanchez, F. ^{[4
,6
]}

Subramaniam, Sinthuri ^{[4
,16
]}

Geigy, Nicolas ^{[18
]}

Keller, Dagmar I. ^{[12
]}

Reichlin, Tobias ^{[1
,2
,4
]}

Mueller, Christian ^{[1
,2
,4
]}

Mueller, Deborah ^{[1
,2
]}

Sazgary, Lorraine ^{[1
,2
]}

Marbot, Stella ^{[1
,2
]}

Sabti, Zaid ^{[3
,4
]}

Flores, Dayana ^{[1
,2
,3
,4
]}

Meissner, Kathrin ^{[1
,2
]}

Kulangara, Caroline ^{[1
,2
]}

Freese, Michael ^{[1
,2
,4
]}

Osswald, Stefan ^{[3
]}

Stelzig, Claudia ^{[1
,2
]}

Bingisser, Roland ^{[3
,4
]}

Lopez, Beatriz ^{[5
]}

Martinez Aguero, Maria ^{[6
]}

Nowalany-Kozielska, Ewa ^{[7
]}

Kawecki, Damian ^{[7
]}

Parenica, Jiri ^{[4
,9
]}

Ganovska, Eva ^{[8
,9
]}

Lohrmann, Jens ^{[1
,2
]}

Buser, Andreas ^{[10
,11
]}

Flores, Dayana ^{[1
,2
,3
,4
]}

Grimm, Karin ^{[1
,2
]}

Hartmann, Beate ^{[1
,2
]}

Muzyk, Piotr ^{[7
]}

Rentsch, Katharina ^{[13
]}

von Eckardstein, Arnold ^{[12
,14
]}

机构：

[1] Univ Basel, Univ Basel Hosp, CRIB, Basel, Switzerland

[2] Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland

[3] Univ Basel, Univ Basel Hosp, Dept Emergency Med, Basel, Switzerland

[4] GREAT Network, Rome, Italy

[5] Hosp Clin Barcelona, Emergency Dept, Barcelona, Catalonia, Spain

[6] Hosp Clin San Carlos, Serv Urgencias, Madrid, Spain

[7] Med Univ Katowice, Dept Cardiol 2, Div Dent Zabrze, Katowice, Poland

[8] Univ Hosp Brno, Dept Cardiol, Brno, Czech Republic

[9] Masaryk Univ, Fac Med, Brno, Czech Republic

[10] Swiss Red Cross, Ctr Blood Transfus, Basel, Switzerland

[11] Univ Basel, Dept Hematol, Univ Basel Hosp, Basel, Switzerland

[12] Univ Hosp Zurich, Emergency Dept, Zurich, Switzerland

[13] Univ Hosp Basel, Dept Lab Med, Basel, Switzerland

[14] Univ Hosp Zurich, Dept Lab Med, Zurich, Switzerland

[15] Prince Charles Hosp, Crit Care Res Grp, Brisbane, Qld, Australia

[16] Univ Basel, Univ Basel Hosp, Dept Internal Med, Basel, Switzerland

[17] Hamburg Univ, Ctr Heart, Dept Gen & Intervent Cardiol, Hamburg, Germany

[18] Kantonsspital Liestal, Emergency Dept, Liestal, Switzerland

来源：

INTERNATIONAL JOURNAL OF CARDIOLOGY | 2019年 / 283卷

基金：

瑞士国家科学基金会;

关键词：

Acute myocardial infarction; Diagnosis; Rule-out; High-sensitivity cardiac troponin T and I; Rule-out algorithm; Efficacy; SENSITIVITY CARDIAC TROPONIN; EARLY-DIAGNOSIS; RAPID RULE; EMERGENCY-DEPARTMENT; INCREMENTAL VALUE; 2-HOUR ALGORITHM; VALIDATION; COPEPTIN; PROTOCOL; DISEASE;

D O I：

10.1016/j.ijcard.2018.11.140

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: The clinical availability of high-sensitivity cardiac troponin (hs-cTn) has enabled the development of several innovative strategies for the rapid rule-out of acute myocardial infarction (AMI). Due to the lack of direct comparisons, selection of the best strategy for clinical practice is challenging. Methods: In a prospective international multicenter diagnostic study enrolling 3696 patients presenting with suspected AMI to the emergency department, we compared the safety and efficacy of 14 different hs-cTn-based strategies: hs-cTn concentrations below the limit of detection (LoD), dual-marker combining hs-cTn with copeptin, ESC 0 h/1 h-algorithm, 0 h/2 h-algorithm, 2 h-ADP-algorithm, NICE-algorithm, and ESC 0 h/3 h-algorithm, each using either hs-cTnT or hs-cTnI. The final diagnosis of AMI was adjudicated by two independent cardiologists using all available clinical information including cardiac imaging and serial hs-cTn concentrations. Results: AMI was the final diagnosis in 16% of patients. Using hs-cTnT, safety quantified by the negative predictive value (NPV) and sensitivity was very high (99.8-100% and 99.5-100%) and comparable for all strategies, except the dual-marker approach (NPV 98.7%, sensitivity 96.7%). Similarly, using hs-cTnI, safety quantified by the NPV and sensitivity was very high (99.7-100% and 98.9-100%) and comparable for all strategies, except the dual-marker approach (NPV 96.9%, sensitivity 90.4%) and the NICE-algorithm (NPV 99.1%, sensitivity 94.7%). Efficacy, quantified by the percentage of patients eligible for rule-out, differed markedly, and was lowest for LoD-algorithm (15.7-26.8%). Conclusion: All rapid rule-out algorithms, except the dual-marker strategy and the NICE-algorithm using hs-cTnI, favorably combine safety and efficacy, and can be considered for routine clinical practice. Clinical trial registration: NCT00470587, http://clinicaltrials.gov/show/NCT00470587. (c) 2018 Elsevier B.V. All rights reserved.

引用

页码：41 / 47

页数：7

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