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Diagnosis of Myocardial Infarction Using a High-Sensitivity Troponin I 1-Hour Algorithm

2016; American Medical Association; Volume: 1; Issue: 4 Linguagem: Inglês

10.1001/jamacardio.2016.0695

2380-6591

Franz‐Josef Neumann, Nils A. Sörensen, Tjark Schwemer, Francisco Ojeda, Rafael Bourry, V. Sciacca, S. Schaefer, Christoph Waldeyer, Christoph Sinning, Thomas Renné, Martin Than, William Parsonage, Karin Wildi, Nataliya Makarova, Renate B. Schnabel, Ulf Landmesser, Christian Mueller, Louise Cullen, Jaimi Greenslade, Tanja Zeller, Stefan Blankenberg, Mahir Karakas, Dirk Westermann,

Cardiac Imaging and Diagnostics

Rapid and accurate diagnosis of acute myocardial infarction (AMI) currently constitutes an unmet need.To test a 1-hour diagnostic algorithm to diagnose AMI using a high-sensitivity troponin I assay with a new cutoff level of 6 ng/L.The Biomarkers in Acute Cardiac Care study is a prospective study that investigated the application of the troponin I assay for the diagnosis of AMI in 1040 patients presenting to the emergency department with acute chest pain from July 19, 2013, to December 31, 2014. Results were validated in 2 independent cohorts of 4009 patients. Final follow-up was completed on July 1, 2015, and data were assessed from July 2 to December 15, 2015.Acute chest pain suggestive of AMI.Accurate diagnosis or exclusion of AMI and 12-month mortality in patients with acute chest pain.Of the 1040 patients included from the study cohort, 673 (64.7%) were male and had a median age of 65 (interquartile range, 52-75) years. With application of a low troponin I cutoff value of 6 ng/L, the rule-out algorithm showed a high negative predictive value of 99.8% (95% CI, 98.6%-100.0%) after 1 hour for non-ST-segment elevation MI type 1. The 1-hour approach was comparable to a 3-hour approach. Similarly, a rule-in algorithm based on troponin I levels provided a high positive predictive value with 82.8% (95% CI, 73.2%-90.0%). Moreover, application of the cutoff of 6 ng/L resulted in lower follow-up mortality (1.0%) compared with the routinely used 99th percentile (3.7%) for this assay. Two independent cohorts further validated the performance of this algorithm with high negative and positive predictive values.Patients with possible AMI can be triaged within 1 hour after admission with no loss of safety compared with a 3-hour approach, when a low and sensitive cutoff is applied. This concept enables safe discharge or rapid treatment initiation after 1 hour.