期刊
AMERICAN JOURNAL OF MEDICINE
卷 128, 期 8, 页码 861-+出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjmed.2015.01.046
关键词
Accurate rule-in; Acute myocardial infarction; hs-cTn; Safe rule-out
资金
- European Union
- Swiss National Science Foundation
- Swiss Heart Foundation
- Cardiovascular Research Foundation Basel
- University Basel
- University Hospital Basel
- 8sense
- Abbott
- Beckman Coulter
- BRAHMS
- Nanosphere
- Roche
- Schiller
- Siemens
OBJECTIVE: We aimed to prospectively derive and validate a novel 1h-algorithm using high-sensitivity cardiac troponin I (hs-cTnI) for early rule-out and rule-in of acute myocardial infarction. METHODS: We performed a prospective multicenter diagnostic study enrolling 1811 patients with suspected acute myocardial infarction. The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including coronary angiography, echocardiography, follow-up data, and serial measurements of hs-cTnT (but not hs-cTnI). The hs-cTnI 1h-algorithm, incorporating measurements performed at baseline and absolute changes within 1 hour, was derived in a randomly selected sample of 906 patients (derivation cohort), and then validated in the remaining 905 patients (validation cohort). RESULTS: Acute myocardial infarction was the final diagnosis in 18% of patients. After applying the hs-cTnI 1h-algorithm developed in the derivation cohort to the validation cohort, 50.5% of patients could be classified as rule-out, 19% as rule-in, 30.5% as observe. In the validation cohort, the negative predictive value for acute myocardial infarction in the rule-out zone was 99.6% (95% confidence interval, 98.4%-100%), and the positive predictive value for acute myocardial infarction in the rule-in zone was 73.9% (95% confidence interval, 66.7%-80.2%). Negative predictive value of the 1h-algorithm was higher compared with the classical dichotomous interpretation of hs-cTnI and to the standard of care combining hs-cTnI with the electrocardiogram (both P < .001). Positive predictive value also was higher compared with the standard of care (P < .001). CONCLUSION: Using a simple algorithm incorporating baseline hs-cTnI values and the absolute change within the first hour allows safe rule-out as well as accurate rule-in of acute myocardial infarction in 70% of patients presenting with suspected acute myocardial infarction. (C) 2015 Elsevier Inc. All rights reserved.
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