Two-Hour Algorithm for Triage toward Rule-Out and Rule-In of Acute Myocardial Infarction by Use of High-Sensitivity Cardiac Troponin I

被引：107

作者：

Boeddinghaus, Jasper ^{[1
,2
,3
]}

Reichlin, Tobias ^{[1
,2
]}

Cullen, Louise ^{[4
,5
]}

Greenslade, Jaimi H. ^{[4
,5
]}

Parsonage, William A. ^{[5
,6
]}

Hammett, Christopher ^{[6
]}

Pickering, John W. ^{[7
,8
]}

Hawkins, Tracey ^{[4
,5
]}

Aldous, Sally ^{[8
]}

Twerenbold, Raphael ^{[1
,2
]}

Wildi, Karin ^{[1
]}

Nestelberger, Thomas ^{[1
,2
,3
]}

Grimm, Karin ^{[1
,2
,3
]}

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

Puelacher, Christian ^{[1
]}

Kern, Vera ^{[1
]}

Rentsch, Katharina ^{[9
]}

Than, Martin ^{[8
]}

Mueller, Christian ^{[1
,2
]}

机构：

[1] Univ Basel Hosp, CRIB, Petersgraben 4, CH-4031 Basel, Switzerland

[2] Univ Basel Hosp, Dept Cardiol, CH-4031 Basel, Switzerland

[3] Univ Basel Hosp, Dept Internal Med, CH-4031 Basel, Switzerland

[4] Royal Brisbane & Womens Hosp, Dept Emergency Med, Brisbane, Qld, Australia

[5] Queensland Univ Technol, Sch Publ Hlth, Brisbane, Qld 4001, Australia

[6] Univ Queensland, Sch Med, Brisbane, Qld, Australia

[7] Univ Otago, Dept Med, Christchurch, New Zealand

[8] Christchurch Hosp, Emergency Dept, Christchurch, New Zealand

[9] Univ Basel Hosp, Lab Med, CH-4031 Basel, Switzerland

来源：

CLINICAL CHEMISTRY | 2016年 / 62卷 / 03期

基金：

瑞士国家科学基金会;

关键词：

ACUTE CORONARY SYNDROME; ACCELERATED DIAGNOSTIC PROTOCOL; CHEST-PAIN SYMPTOMS; EMERGENCY-DEPARTMENT; T ASSAY; RISK STRATIFICATION; 30-DAY OUTCOMES; VALIDATION; POPULATION; CLASSIFICATION;

D O I：

10.1373/clinchem.2015.249508

中图分类号：

R446 [实验室诊断]; R-33 [实验医学、医学实验];

学科分类号：

1001 ;

摘要：

BACKGROUND: The early triage of patients toward ruleout and rule-in of acute myocardial infarction (AMI) is challenging. Therefore, we aimed to develop a 2-h algorithm that uses high-sensitivity cardiac troponin I (hs-cTnI). METHODS: We prospectively enrolled 1435 (derivation cohort) and 1194 (external validation cohort) patients presenting with suspected AMI to the emergency department. The final diagnosis was adjudicated by 2 independent cardiologists. hs-cTnI was measured at presentation and after 2 h in a blinded fashion. We derived and validated a diagnostic algorithm incorporating hs-cTnI values at presentation and absolute changes within the first 2 h. RESULTS: AMI was the final diagnosis in 17% of patients in the derivation and 13% in the validation cohort. The 2-h algorithm developed in the derivation cohort classified 56% of patients as rule-out, 17% as rule-in, and 27% as observation. Resulting diagnostic sensitivity and negative predictive value (NPV) were 99.2% and 99.8% for rule-out; specificity and positive predictive value (PPV) were 95.2% and 75.8% for rule-in. Applying the 2-h algorithm in the external validation cohort, 60% of patients were classified as rule-out, 13% as rule-in, and 27% as observation. Diagnostic sensitivity and NPV were 98.7% and 99.7% for rule-out; specificity and PPV were 97.4% and 82.2% for rule-in. Thirty-day survival was 100% for rule-out patients in both cohorts. CONCLUSIONS: A simple algorithm incorporating hs-cTnI baseline values and absolute 2-h changes allowed a triage toward safe rule-out or accurate rule-in of AMI in the majority of patients. (C) 2015 American Association for Clinical Chemistry

引用

页码：494 / 504

页数：11

共 41 条

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