A 1-h Combination Algorithm Allows Fast Rule-Out and Rule-In of Major Adverse Cardiac Events
(2016) In Journal of the American College of Cardiology 67(13). p.1531-1540- Abstract
- Background
A 1-h algorithm based on high-sensitivity cardiac troponin T (hs-cTnT) testing at presentation and again 1 h thereafter has been shown to accurately rule out acute myocardial infarction.
Objectives
The goal of the study was to evaluate the diagnostic accuracy of the 1-h algorithm when supplemented with patient history and an electrocardiogram (ECG) (the extended algorithm) for predicting 30-day major adverse cardiac events (MACE) and to compare it with the algorithm using hs-cTnT alone (the troponin algorithm).
Methods
This prospective observational study enrolled consecutive patients presenting to the emergency department (ED) with chest pain, for whom hs-cTnT testing was ordered at presentation.... (More) - Background
A 1-h algorithm based on high-sensitivity cardiac troponin T (hs-cTnT) testing at presentation and again 1 h thereafter has been shown to accurately rule out acute myocardial infarction.
Objectives
The goal of the study was to evaluate the diagnostic accuracy of the 1-h algorithm when supplemented with patient history and an electrocardiogram (ECG) (the extended algorithm) for predicting 30-day major adverse cardiac events (MACE) and to compare it with the algorithm using hs-cTnT alone (the troponin algorithm).
Methods
This prospective observational study enrolled consecutive patients presenting to the emergency department (ED) with chest pain, for whom hs-cTnT testing was ordered at presentation. Hs-cTnT results at 1 h and the ED physician’s assessments of patient history and ECG were collected. The primary outcome was an adjudicated diagnosis of 30-day MACE defined as acute myocardial infarction, unstable angina, cardiogenic shock, ventricular arrhythmia, atrioventricular block, cardiac arrest, or death of a cardiac or unknown cause.
Results
In the final analysis, 1,038 patients were included. The extended algorithm identified 60% of all patients for rule-out and had a higher sensitivity than the troponin algorithm (97.5% vs. 87.6%; p < 0.001). The negative predictive value was 99.5% and the likelihood ratio was 0.04 with the extended algorithm versus 97.8% and 0.17, respectively, with the troponin algorithm. The extended algorithm ruled-in 14% of patients with a higher sensitivity (75.2% vs. 56.2%; p < 0.001) but a slightly lower specificity (94.0% vs. 96.4%; p < 0.001) than the troponin algorithm. The rule-in arms of both algorithms had a likelihood ratio >10.
Conclusions
A 1-h combination algorithm allowed fast rule-out and rule-in of 30-day MACE in a majority of ED patients with chest pain and performed better than the troponin-alone algorithm. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/4ffbe584-a2d9-48bb-89b9-4a50e47be0b2
- author
- MOKHTARI, ARASH LU ; Cedercrantz-Borna, Catharina LU ; GILJE, PATRIK LU ; Tydén, Patrik LU ; Lindahl, Bertil ; Nilsson, Hans-Jörgen ; KHOSHNOOD, ARDAVAN LU ; Björk, Jonas LU and Ekelund, Ulf LU
- organization
- publishing date
- 2016
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Troponin, ACS, Chest pain, Acute coronary syndrome, Troponin, AKS, Bröstsmärta, Akut Koronart Syndrom
- in
- Journal of the American College of Cardiology
- volume
- 67
- issue
- 13
- pages
- 10 pages
- publisher
- Elsevier
- external identifiers
-
- wos:000372893300006
- pmid:27150684
- scopus:85008912351
- ISSN
- 0735-1097
- DOI
- 10.1016/j.jacc.2016.01.059
- project
- AIR Lund Chest pain - More efficient and equal emergency care with advanced medical decision support tools
- language
- English
- LU publication?
- yes
- id
- 4ffbe584-a2d9-48bb-89b9-4a50e47be0b2
- alternative location
- https://www.sciencedirect.com/science/article/pii/S0735109716006112?via%3Dihub
- date added to LUP
- 2016-05-02 08:56:49
- date last changed
- 2024-02-18 16:57:35
@article{4ffbe584-a2d9-48bb-89b9-4a50e47be0b2, abstract = {{Background<br> A 1-h algorithm based on high-sensitivity cardiac troponin T (hs-cTnT) testing at presentation and again 1 h thereafter has been shown to accurately rule out acute myocardial infarction.<br> <br> Objectives<br> The goal of the study was to evaluate the diagnostic accuracy of the 1-h algorithm when supplemented with patient history and an electrocardiogram (ECG) (the extended algorithm) for predicting 30-day major adverse cardiac events (MACE) and to compare it with the algorithm using hs-cTnT alone (the troponin algorithm).<br> <br> Methods<br> This prospective observational study enrolled consecutive patients presenting to the emergency department (ED) with chest pain, for whom hs-cTnT testing was ordered at presentation. Hs-cTnT results at 1 h and the ED physician’s assessments of patient history and ECG were collected. The primary outcome was an adjudicated diagnosis of 30-day MACE defined as acute myocardial infarction, unstable angina, cardiogenic shock, ventricular arrhythmia, atrioventricular block, cardiac arrest, or death of a cardiac or unknown cause.<br> <br> Results<br> In the final analysis, 1,038 patients were included. The extended algorithm identified 60% of all patients for rule-out and had a higher sensitivity than the troponin algorithm (97.5% vs. 87.6%; p < 0.001). The negative predictive value was 99.5% and the likelihood ratio was 0.04 with the extended algorithm versus 97.8% and 0.17, respectively, with the troponin algorithm. The extended algorithm ruled-in 14% of patients with a higher sensitivity (75.2% vs. 56.2%; p < 0.001) but a slightly lower specificity (94.0% vs. 96.4%; p < 0.001) than the troponin algorithm. The rule-in arms of both algorithms had a likelihood ratio >10.<br> <br> Conclusions<br> A 1-h combination algorithm allowed fast rule-out and rule-in of 30-day MACE in a majority of ED patients with chest pain and performed better than the troponin-alone algorithm.}}, author = {{MOKHTARI, ARASH and Cedercrantz-Borna, Catharina and GILJE, PATRIK and Tydén, Patrik and Lindahl, Bertil and Nilsson, Hans-Jörgen and KHOSHNOOD, ARDAVAN and Björk, Jonas and Ekelund, Ulf}}, issn = {{0735-1097}}, keywords = {{Troponin; ACS; Chest pain; Acute coronary syndrome; Troponin; AKS; Bröstsmärta; Akut Koronart Syndrom}}, language = {{eng}}, number = {{13}}, pages = {{1531--1540}}, publisher = {{Elsevier}}, series = {{Journal of the American College of Cardiology}}, title = {{A 1-h Combination Algorithm Allows Fast Rule-Out and Rule-In of Major Adverse Cardiac Events}}, url = {{http://dx.doi.org/10.1016/j.jacc.2016.01.059}}, doi = {{10.1016/j.jacc.2016.01.059}}, volume = {{67}}, year = {{2016}}, }