Direct Comparison of the 0/1h and 0/3h Algorithms for Early Rule-Out of Acute Myocardial Infarction
2018; Lippincott Williams & Wilkins; Volume: 137; Issue: 23 Linguagem: Inglês
10.1161/circulationaha.118.034260
ISSN1524-4539
AutoresPatrick Badertscher, Jasper Boeddinghaus, Raphael Twerenbold, Thomas Nestelberger, Karin Wildi, Desiree Wussler, Jonas Andersson Schwarz, Christian Puelacher, María Rubini Giménez, Nikola Kozhuharov, Jeanne du Fay de Lavallaz, Sara E. Cerminara, Eliška Potluková, Katharina Rentsch, Òscar Miró, Beatriz López, Francisco Javier Martín‐Sánchez, Beata Morawiec, Piotr Muzyk, Dagmar I. Keller, Tobias Reichlin, Christian Mueller, Zaid Sabti, Ivo Strebel, Samyut Shrestha, Dayana Flores, Michael Freese, Claudia Stelzig, Caroline Kulangara, Kathrin Meissner, Nicolas Schaerli, Deborah Mueller, Ana Yufera Sanchez, Lorraine Sazgary, Stella Marbot, Carolina Fuenzalida, Sofía Calderón, Esther Rodríguez Adrada, Damian Kawecki, Ewa Nowalany-Kozielska, Jiří Pařenica, Eva Ganovská, Arnold von Eckardstein, Jens Lohrmann, Wanda Kloos, Stefan Osswald, Andreas Buser, Roland Bingisser, Nicolas Geigy,
Tópico(s)Cardiac Imaging and Diagnostics
ResumoHomeCirculationVol. 137, No. 23Direct Comparison of the 0/1h and 0/3h Algorithms for Early Rule-Out of Acute Myocardial Infarction Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessLetterPDF/EPUBDirect Comparison of the 0/1h and 0/3h Algorithms for Early Rule-Out of Acute Myocardial Infarction Patrick Badertscher, MD, Jasper Boeddinghaus, MD, Raphael Twerenbold, MD, Thomas Nestelberger, MD, Karin Wildi, MD, Desiree Wussler, MD, Jonas Schwarz, MD, Christian Puelacher, MD, Maria Rubini Giménez, MD, Nikola Kozhuharov, MD, Jeanne du Fay de Lavallaz, MD, Sara Elisa Cerminara, MS, Eliska Potlukova, MD, Katharina Rentsch, PhD, Òscar Miró, MD, Beatriz López, MD, F. Javier Martin-Sanchez, MD, Beata Morawiec, MD, Piotr Muzyk, MD, Dagmar I. Keller, MD, Tobias Reichlin, MD and Christian Mueller, MDfor the APACE Investigators Zaid Sabti, Ivo Strebel, Samyut Shrestha, Dayana Flores, Michael Freese, Claudia Stelzig, Caroline Kulangara, Kathrin Meissner, Nicolas Schaerli, Deborah Mueller, Ana Yufera Sanchez, Lorraine Sazgary, Stella Marbot, Carolina Fuenzalida, Sofia Calderón, Esther Rodriguez Adrada, Damian Kawecki, Ewa Nowalany-Kozielska, Jiri Parenica, Eva Ganovská, Arnold von Eckardstein, Jens Lohrmann, Wanda Kloos, Stefan Osswald, Andreas Buser, Roland Bingisser and Nicolas Geigy Patrick BadertscherPatrick Badertscher Cardiovascular Research Institute Basel and Department of Cardiology (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., S.E.C., E.P., T.R., C.M.) GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). , Jasper BoeddinghausJasper Boeddinghaus Cardiovascular Research Institute Basel and Department of Cardiology (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., S.E.C., E.P., T.R., C.M.) Department of Internal Medicine (J.B., M.R.G., E.P.) GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). , Raphael TwerenboldRaphael Twerenbold Cardiovascular Research Institute Basel and Department of Cardiology (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., S.E.C., E.P., T.R., C.M.) GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). Department of General and Interventional Cardiology, Hamburg University Heart Center, Germany (R.T.). , Thomas NestelbergerThomas Nestelberger Cardiovascular Research Institute Basel and Department of Cardiology (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., S.E.C., E.P., T.R., C.M.) GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). , Karin WildiKarin Wildi Cardiovascular Research Institute Basel and Department of Cardiology (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., S.E.C., E.P., T.R., C.M.) GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). , Desiree WusslerDesiree Wussler Cardiovascular Research Institute Basel and Department of Cardiology (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., S.E.C., E.P., T.R., C.M.) GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). , Jonas SchwarzJonas Schwarz Cardiovascular Research Institute Basel and Department of Cardiology (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., S.E.C., E.P., T.R., C.M.) GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). , Christian PuelacherChristian Puelacher Cardiovascular Research Institute Basel and Department of Cardiology (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., S.E.C., E.P., T.R., C.M.) GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). , Maria Rubini GiménezMaria Rubini Giménez Cardiovascular Research Institute Basel and Department of Cardiology (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., S.E.C., E.P., T.R., C.M.) Department of Internal Medicine (J.B., M.R.G., E.P.) GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). , Nikola KozhuharovNikola Kozhuharov Cardiovascular Research Institute Basel and Department of Cardiology (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., S.E.C., E.P., T.R., C.M.) GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). , Jeanne du Fay de LavallazJeanne du Fay de Lavallaz Cardiovascular Research Institute Basel and Department of Cardiology (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., S.E.C., E.P., T.R., C.M.) GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). , Sara Elisa CerminaraSara Elisa Cerminara Cardiovascular Research Institute Basel and Department of Cardiology (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., S.E.C., E.P., T.R., C.M.) , Eliska PotlukovaEliska Potlukova Cardiovascular Research Institute Basel and Department of Cardiology (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., S.E.C., E.P., T.R., C.M.) Department of Internal Medicine (J.B., M.R.G., E.P.) , Katharina RentschKatharina Rentsch Laboratory Medicine (K.R.), University Hospital Basel, University of Basel, Switzerland. , Òscar MiróÒscar Miró GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). Emergency Department, Hospital Clinic, Barcelona, Spain (O.M., B.L.). , Beatriz LópezBeatriz López GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). Emergency Department, Hospital Clinic, Barcelona, Spain (O.M., B.L.). , F. Javier Martin-SanchezF. Javier Martin-Sanchez GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain (F.J.M.-S.). , Beata MorawiecBeata Morawiec GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). Second Department of Cardiology, Medical University of Silesia, Zabrze, Poland (B.M., P.M.). , Piotr MuzykPiotr Muzyk Second Department of Cardiology, Medical University of Silesia, Zabrze, Poland (B.M., P.M.). , Dagmar I. KellerDagmar I. Keller Emergency Department, University Hospital Zurich, Switzerland (D.I.K.). , Tobias ReichlinTobias Reichlin Cardiovascular Research Institute Basel and Department of Cardiology (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., S.E.C., E.P., T.R., C.M.) GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). and Christian MuellerChristian Mueller Cardiovascular Research Institute Basel and Department of Cardiology (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., S.E.C., E.P., T.R., C.M.) GREAT Network, Rome, Italy (P.B., J.B., R.T., T.N., K.W., D.W., J.S., C.P., M.R.G., N.K., J.d.F.d.L., O.M., B.L., F.J.M.-S., B.M., T.R., C.M.). Zaid SabtiZaid Sabti , Ivo StrebelIvo Strebel , Samyut ShresthaSamyut Shrestha , Dayana FloresDayana Flores , Michael FreeseMichael Freese , Claudia StelzigClaudia Stelzig , Caroline KulangaraCaroline Kulangara , Kathrin MeissnerKathrin Meissner , Nicolas SchaerliNicolas Schaerli , Deborah MuellerDeborah Mueller , Ana Yufera SanchezAna Yufera Sanchez , Lorraine SazgaryLorraine Sazgary , Stella MarbotStella Marbot , Carolina FuenzalidaCarolina Fuenzalida , Sofia CalderónSofia Calderón , Esther Rodriguez AdradaEsther Rodriguez Adrada , Damian KaweckiDamian Kawecki , Ewa Nowalany-KozielskaEwa Nowalany-Kozielska , Jiri ParenicaJiri Parenica , Eva GanovskáEva Ganovská , Arnold von EckardsteinArnold von Eckardstein , Jens LohrmannJens Lohrmann , Wanda KloosWanda Kloos , Stefan OsswaldStefan Osswald , Andreas BuserAndreas Buser , Roland BingisserRoland Bingisser and Nicolas GeigyNicolas Geigy and for the APACE Investigators Originally published5 Jun 2018https://doi.org/10.1161/CIRCULATIONAHA.118.034260Circulation. 2018;137:2536–2538Patients with symptoms suggestive of acute myocardial infarction (AMI) account for ≈10% of all emergency department (ED) presentations.1 The majority of patients are finally found to have diagnoses other than AMI.2 Thus, the expeditious evaluation of such patients is important because delays in ruling out AMI may interfere with the detection of other underlying diseases. The 0/1 hour (0/1h) algorithm and the 0/3 hour (0/3h) algorithm are both recommended by the European Society of Cardiology with a Class I recommendation for the early rule-out of AMI.1 The 0/1h algorithm and 0/3h algorithm are completely different protocols. Whereas the 0/1h algorithm uses high-sensitivity cardiac troponin (hs-cTn) concentrations at presentation and absolute changes within the first hour and hence takes optimal advantage of the increased diagnostic accuracy and precision of hs-cTn assays, the 0/3h algorithm uses a fixed threshold protocol based on the 99th percentile at presentation and 3 hours in conjunction with clinical criteria (GRACE [Global Registry of Acute Coronary Events] score <140 and the need to be pain free). It is currently unknown whether 1 algorithm is preferable to the other.The aim of this study was to directly compare safety, quantified by the negative predictive value (NPV) and the negative likelihood ratio (LR) for the presence of AMI, and efficacy, quantified by the proportion of patients triaged toward rule-out in a large diagnostic multicenter study enrolling patients presenting with suspected AMI to the ED (URL: https://www.clinicaltrials.gov. Unique identifier: NCT00470587). The study was carried out according to the principles of the Declaration of Helsinki and approved by the local ethics committees. Written informed consent was obtained from all patients. Patients presenting with ST-segment–elevation MI were excluded. Triage toward rule-out by the 0/1h or the 0/3h algorithm was compared against the final adjudication performed by 2 independent cardiologists using all information, including cardiac imaging and serial hs-cTnT measurements. Analyses were performed with hs-cTnT and hs-cTnI. NPV and efficacy were compared by the McNemar test and Pearson χ2 test, respectively. The 95% confidence intervals (CIs) were calculated with the Wilson score method without continuity correction.Among 2547 patients eligible for analysis with hs-cTnT, AMI was the final adjudicated diagnosis in 387 patients (15%). The 0/1h algorithm provided safety similar to that of the 0/3h algorithm (NPV, 99.8% [95% CI, 99.4–99.9] and negative LR, 0.01 [95% CI, 0.00–0.03] versus NPV, 99.7% [95% CI, 99.2–99.9] and negative LR, 0.02 [95% CI, 0.00–0.05]) but allowed the rule-out of significantly more patients compared with the 0/3h algorithm (60% versus 44%; P 2 hours) with 99.9% (95% CI, 99.5–100) versus 99.6% (95% CI, 98.9–99.9), respectively. The 0/1h algorithm allowed the rule-out of more patients compared with the 0/3h algorithm in early presenters (64% versus 49%; P<0.001) and in late presenters (59% versus 42%; P<0.001). Findings were confirmed with hs-cTnI and with 30-day survival used as an additional outcome measure for safety, with survival rates of 99.9% to 100% for patients triaged toward rule-out by both algorithms.These findings corroborate and extend previous work on the development and validation of safe and effective rule-out strategies for AMI and have important clinical implications.3–5 The excellent safety achieved with both algorithms documents the suitability of most of these patients for early discharge and outpatient management. Beyond the more favorable combination of safety and efficacy by the 0/1h algorithm versus the 0/3h algorithm, the following features may help physicians and institutions in the selection of their preferred triage algorithm. First, the 0/1h algorithm has the obvious and important additional advantage of allowing clinical decision making 2 hours earlier compared with the 0/3h algorithm. Because most patients triaged toward early rule-out are also candidates for direct discharge from the ED, it is very likely that it will reduce time to discharge and treatment cost in the ED. Second, the 0/1h algorithm does not require the use of a specific risk score, which further increases its feasibility. Previous studies have documented that omitting any of the 3 elements of the 0/3h algorithm (hs-cTn, GRACE score, pain-free criterion) in an effort to simplify the approach would worsen its safety and is therefore discouraged. Third, when putting our findings into clinical perspective, it is important to highlight that the 0/1h algorithm and the 0/3h algorithm should always be used in conjunction with all clinical information available. This is of paramount importance because, among patients presenting with acute chest discomfort to the ED, the rule-out of AMI is related to the possibility of rapid discharge and outpatient management but not identical to it.In conclusion, the 0/1h algorithm is superior to the 0/3h algorithm using hs-cTnT as well as hs-cTnI because it more favorably combines safety with efficacy.Download figureDownload PowerPointFigure. Direct comparison of the 0/1h and 0/3h algorithms for early rule-out of AMI using hs-cTnT (A) and hs-cTnI (B). The figure illustrates both coprimary end points: safety, as quantified by the negative predictive value (NPV; percent), and efficacy (proportion of patients assigned to ruled out; percent). Bars represent 95% confidence intervals. AMI indicates acute myocardial infarction; and hs-cTn, high-sensitivity cardiac troponin.Sources of FundingThe study was supported by research grants from the Swiss National Science Foundation, the European Union, the Swiss Heart Foundation, Abbott, Beckman Coulter, BRAHMS, Roche, Siemens, 8sense, Nanosphere, Alere, and the Department of Internal Medicine, University Hospital Basel.DisclosuresThe authors designed the study, gathered and analyzed the data, vouched for the data and analysis, wrote the article, and decided to publish. Drs. Badertscher, Boeddinghaus, and Mueller had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and approved the article. The sponsors had no role in designing or conducting the study and no role in gathering or analyzing the data or writing the article. The article and its contents have not been published previously and are not being considered for publications elsewhere in whole or in part in any language, including publicly accessible web sites or e-print servers. Dr. Boeddinghaus received speaker honoraria from Siemens and research grants from the University of Basel and the Department of Internal Medicine. Dr. Twerenbold has received research support from the Swiss National Science Foundation (P300PB-167803), the University of Basel, the University Hospital of Basel, and the Cardiovascular Research Foundation Basel, as well as speaker honoraria/consulting honoraria from Roche, Abbott, Brahms, Siemens, and Singulex. Dr. Rubini received speaker honoraria from Abbott and research support from the Swiss Heart Foundation. Dr. Reichlin has received research grants from the Goldschmidt-Jacobson-Foundation, the Swiss National Science Foundation (PASMP3-136995), the Swiss Heart Foundation, the Professor Max Cloëtta Foundation, the Uniscientia Foundation Vaduz, the University of Basel, and the Department of Internal Medicine, University Hospital Basel, as well as speaker honoraria from Brahms and Roche. Dr. Mueller has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the KTI, the Stiftung für kardiovaskuläre Forschung Basel, Abbott, Alere, AstraZeneca, Beckman Coulter, Biomerieux, Brahms, Roche, Siemens, Singulex, Sphingotec, and the Department of Internal Medicine, University Hospital Basel, as well as speaker honoraria/consulting honoraria from Abbott, Alere, AstraZeneca, Biomerieux, Boehringer Ingelheim, BMS, Brahms, Cardiorentis, Novartis, Roche, Siemens, and Singulex. The other authors report no conflicts. The investigated hs-cTn assays were donated by the manufacturers, who had no role in the design of the study, the analysis of the data, the preparation of the article, or the decision to submit the article for publication.AppendixAdditional APACE Investigators: Zaid Sabti; Ivo Strebel; Samyut Shrestha; Dayana Flores; Michael Freese; Claudia Stelzig; Caroline Kulangara; Kathrin Meissner; Nicolas Schaerli; Deborah Mueller; Ana Yufera Sanchez; Lorraine Sazgary; Stella Marbot; Carolina Fuenzalida; Sofia Calderón; Esther Rodriguez Adrada; Damian Kawecki; Ewa Nowalany-Kozielska; Jiri Parenica; Eva Ganovská; Arnold von Eckardstein; Jens Lohrmann; Wanda Kloos; Stefan Osswald; Andreas Buser; Roland Bingisser; Nicolas Geigy.Footnotes*Drs Badertscher and Boeddinghaus contributed equally.http://circ.ahajournals.orgData sharing: The data, analytical methods, and study materials will not be made available to other researchers for purposes of reproducing the results or replicating the procedure.Christian Mueller, MD, Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. E-mail [email protected]References1. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S; ESC Scientific Document Group. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC).Eur Heart J. 2016; 37:267–315. doi: 10.1093/eurheartj/ehv320.CrossrefMedlineGoogle Scholar2. Nestelberger T, Wildi K, Boeddinghaus J, Twerenbold R, Reichlin T, Giménez MR, Puelacher C, Jaeger C, Grimm K, Sabti Z, Hillinger P, Kozhuharov N, du Fay de Lavallaz J, Pinck F, Lopez B, Salgado E, Miró Ò, Bingisser R, Lohrmann J, Osswald S, Mueller C. Characterization of the observe zone of the ESC 2015 high-sensitivity cardiac troponin 0h/1h-algorithm for the early diagnosis of acute myocardial infarction.Int J Cardiol. 2016; 207:238–245. doi: 10.1016/j.ijcard.2016.01.112.CrossrefMedlineGoogle Scholar3. Chapman AR, Anand A, Boeddinghaus J, Ferry AV, Sandeman D, Adamson PD, Andrews J, Tan S, Cheng SF, D'Souza M, Orme K, Strachan FE, Nestelberger T, Twerenbold R, Badertscher P, Reichlin T, Gray A, Shah ASV, Mueller C, Newby DE, Mills NL. Comparison of the efficacy and safety of early rule-out pathways for acute myocardial infarction.Circulation. 2017; 135:1586–1596. doi: 10.1161/CIRCULATIONAHA.116.025021.LinkGoogle Scholar4. Boeddinghaus J, Nestelberger T, Twerenbold R, Wildi K, Badertscher P, Cupa J, Bürge T, Mächler P, Corbière S, Grimm K, Giménez MR, Puelacher C, Shrestha S, Flores Widmer D, Fuhrmann J, Hillinger P, Sabti Z, Honegger U, Schaerli N, Kozhuharov N, Rentsch K, Miró Ò, López B, Martin-Sanchez FJ, Rodriguez-Adrada E, Morawiec B, Kawecki D, Ganovská E, Parenica J, Lohrmann J, Kloos W, Buser A, Geigy N, Keller DI, Osswald S, Reichlin T, Mueller C. Direct comparison of 4 very early rule-out strategies for acute myocardial infarction using high-sensitivity cardiac troponin I.Circulation. 2017; 135:1597–1611. doi: 10.1161/CIRCULATIONAHA.116.025661.LinkGoogle Scholar5. Wildi K, Cullen L, Twerenbold R, Greenslade JH, Parsonage W, Boeddinghaus J, Nestelberger T, Sabti Z, Rubini-Giménez M, Puelacher C, Cupa J, Schumacher L, Badertscher P, Grimm K, Kozhuharov N, Stelzig C, Freese M, Rentsch K, Lohrmann J, Kloos W, Buser A, Reichlin T, Pickering JW, Than M, Mueller C. Direct comparison of 2 rule-out strategies for acute myocardial infarction: 2-h accelerated diagnostic protocol vs 2-h algorithm.Clin Chem. 2017; 63:1227–1236. doi: 10.1373/clinchem.2016.268359.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited BySandoval Y, Apple F, Mahler S, Body R, Collinson P and Jaffe A (2022) High-Sensitivity Cardiac Troponin and the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guidelines for the Evaluation and Diagnosis of Acute Chest Pain, Circulation, 146:7, (569-581), Online publication date: 16-Aug-2022. Kaier T, Twerenbold R, Lopez-Ayala P, Nestelberger T, Boeddinghaus J, Alaour B, Huber I, Zhi Y, Koechlin L, Wussler D, Wildi K, Shrestha S, Strebel I, Miro O, Martín-Sánchez J, Christ M, Kawecki D, Keller D, Rubini Gimenez M, Marber M, Mueller C, Freese M, Ratmann P, Prepoudis A, Gualandro D, Geigy N, Reichlin T, Rentsch K, Maier M, Troester V, Gehrke J, Coscia T, Glarner N, Schoepfer H, Buechi M, Walter J, Sanchez A, Puelacher C, du Fay de Lavallaz J, Sanzione A, Schäfer I, Hillinger P, López B, Adrada E, Muzyk P, Morawiec B, Parenica J, Ganovská E, Lohrmann J, Buser A, von Eckardstein A, Bingisser R and Nickel C (2022) A 0/1h-algorithm using cardiac myosin-binding protein C for early diagnosis of myocardial infarction, European Heart Journal. Acute Cardiovascular Care, 10.1093/ehjacc/zuac007, 11:4, (325-335), Online publication date: 7-Jun-2022. Roth S and Lurati Buse G (2022) Myokardinfarkt in der HerzchirurgieMyocardial Infarction in Cardiac Surgery, Wiener klinisches Magazin, 10.1007/s00740-021-00428-7, 25:2, (78-81), Online publication date: 1-Apr-2022. (2022) Chest Pain, Dyspnea, Palpitations Practical Cardiovascular Medicine, 10.1002/9781119832737.ch27, (561-569), Online publication date: 4-Mar-2022. (2022) Non‐ST‐Segment Elevation Acute Coronary Syndrome Practical Cardiovascular Medicine, 10.1002/9781119832737.ch1, (1-37), Online publication date: 4-Mar-2022. Limapichat T and Kaewyingyong S (2022) Association of Prolonged Emergency Department Length of Stay with Adverse Events in Patients with Non-ST-Elevation Acute Coronary Syndrome, Open Access Emergency Medicine, 10.2147/OAEM.S353630, Volume 14, (109-117) Wildi K, Boeddinghaus J, Nestelberger T, Lopez-Ayala P, Yufera Sanchez A, Okamura B, Shrestha S, Rohner J, Miró Ò, Martinez-Nadal G, Martin-Sanchez F, Koechlin L, Twerenbold R, Christ M, Kawecki D, Rubini Giménez M, Keller D, Mueller C, Wussler D, Strebel A, Bakula S, Frey D, Gualandro T, Zimmermann C, Puelacher J, du Fay de Lavallaz E, Potlukova M, Diebold N, Geigy K, Rentsch S, Mitrovic C, Fuenzalida N, Glarner B, Munzk T, Breidthardt M, Freese B, López S, Calderón E, Adrada E, Ganovská J, Parenica A, von Eckardstein I, Campodarve J and Gea (2021) 0/2 h-Algorithm for Rapid Triage of Suspected Myocardial Infarction Using a Novel High-Sensitivity Cardiac Troponin I Assay, Clinical Chemistry, 10.1093/clinchem/hvab203, 68:2, (303-312), Online publication date: 1-Feb-2022. Chiang C, Chiang C, Pickering J, Stoyanov K, Chew D, Neumann J, Ojeda F, Sörensen N, Su K, Kavsak P, Worster A, Inoue K, Johannessen T, Atar D, Amann M, Hochholzer W, Mokhtari A, Ekelund U, Twerenbold R, Mueller C, Bahrmann P, Buttinger N, Dooley M, Ruangsomboon O, Nowak R, DeFilippi C, Peacock W, Neilan T, Liu M, Hsu W, Lee G, Tang P, Ma K, Westermann D, Blankenberg S, Giannitsis E, Than M and Lee C (2022) Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction, Annals of Internal Medicine, 10.7326/M21-1499, 175:1, (101-113), Online publication date: 1-Jan-2022. Roth S and Lurati Buse G (2021) Neue kardiale Biomarker zur frühen Detektion des Myokardinfarktes in der HerzchirurgieNew cardiac biomarkers for early detection of myocardial infarction in cardiac surgery, Der Anaesthesist, 10.1007/s00101-021-00974-z, 70:12, (1040-1043), Online publication date: 1-Dec-2021. Barbarash O, Komarov A, Panchenko E, Staroverov I, Shahnovich R and Yavelov I (2021) Eurasian clinical guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndrome (NSTE-ACS), Eurasian heart journal, 10.38109/2225-1685-2021-4-6-59:4, (6-59) Breuckmann F, Settelmeier S, Rassaf T, Post F, Haerer W, Bauersachs J, Mudra H, Voigtländer T, Senges J, Münzel T and Giannitsis E (2021) Survey of clinical practice pattern in Germany's certified chest pain unitsVersorgungsanalyse unter den deutschen zertifizierten Chest Pain Units, Herz, 10.1007/s00059-021-05079-2 Lopez-Ayala P, Nestelberger T, Boeddinghaus J, Koechlin L, Ratmann P, Strebel I, Gehrke J, Meier S, Walter J, Rubini Gimenez M, Mutschler E, Miró Ò, López-Barbeito B, Martín-Sánchez F, Rodríguez-Adrada E, Keller D, Newby L, Twerenbold R, Giannitsis E, Lindahl B, Mueller C, Zimmermann T, Schoepfer H, Coscia T, Troester V, Reichlin T, Kaeslin M, Christ M, Meier M, Badertscher P, Puelacher C, du Fay de Lavallaz J, Potlukova E, Kawecki D, Geigy N, Rentsch K, Shrestha S, Morawiec B, Munzk P, Breidthardt T, Freese M, Martinez-Nadal G, Fuenzalida C, Calderón S, Rodriguez Adrada E, Ganovská E, Parenica J, von Eckardstein A, Campodarve I, Gea J, Mccord J, Nowak R, Body R, deFilippi C, Christenson R, Panteghini M, Plebani M, Verschuren F, French J, Weiser S and Jernberg T (2021) Novel Criteria for the Observe-Zone of the ESC 0/1h-hs-cTnT Algorithm, Circulation, 144:10, (773-787), Online publication date: 7-Sep-2021. Giannitsis E, Blankenberg S, Christenson R, Frey N, von Haehling S, Hamm C, Inoue K, Katus H, Lee C, McCord J, Möckel M, Chieh J, Tubaro M, Wollert K and Huber K (2021) Critical appraisal of the 2020 ESC guideline recommendations on diagnosis and risk assessment in patients with suspected non-ST-segment elevation acute coronary syndrome, Clinical Research in Cardiology, 10.1007/s00392-021-01821-2, 110:9, (1353-1368), Online publication date: 1-Sep-2021. Collet J, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt D, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale C, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis B, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten F, Sibbing D and Siontis G (2021) Guía ESC 2020 sobre el diagnóstico y tratamiento del síndrome coronario agudo sin elevación del segmento ST, Revista Española de Cardiología, 10.1016/j.recesp.2020.12.024, 74:6, (544.e1-544.e73), Online publication date: 1-Jun-2021. Guedeney P, Collet J, Ecollan P and Montalescot G (2021) Prise en charge du syndrome coronaire aigu sans élévation du segment ST, nouveautés des recommandations ESC 2020, Journal Européen des Urgences et de Réanimation, 10.1016/j.jeurea.2021.04.004, 33:2, (82-87), Online publication date: 1-Jun-2021. Westwood M, Ramaekers B, Grimm S, Worthy G, Fayter D, Armstrong N, Buksnys T, Ross J, Joore M and Kleijnen J (2021) High-sensitivity troponin assays for early rule-out of acute myocardial infarction in people with acute chest pain: a systematic review and economic evaluation, Health Technology Assessment, 10.3310/hta25330, 25:33, (1-276) Wildi K, Boeddinghaus J, Nestelberger T, Haaf P, Koechlin L, Ayala Lopez P, Walter J, Badertscher P, Ratmann P, Miró Ò, Martin-Sanchez F, Muzyk P, Kaeslin M, RubiniGiménez M, M. Gualandro D, Buergler F, Keller D, Christ M, Twerenbold R and Mueller C (2021) External validation of the clinical chemistry score, Clinical Biochemistry, 10.1016/j.clinbiochem.2021.02.006, 91, (16-25), Online publication date: 1-May-2021. Collet J, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt D, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale C, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis B, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten F, Sibbing D, Siontis G, Kastrati A, Mamas M, Aboyans V, Angiolillo D, Bueno H, Bugiardini R, Byrne R, Castelletti S, Chieffo A, Cornelissen V, Crea F, Delgado V, Drexel H, Gierlotka M, Halvorsen S, Haugaa K, Jankowska E, Katus H, Kinnaird T, Kluin J, Kunadian V, Landmesser U, Leclercq C, Lettino M, Meinila L, Mylotte D, Ndrepepa G, Omerovic E, Pedretti R, Petersen S, Petronio A, Pontone G, Popescu B, Potpara T, Ray K, Luciano F, Richter D, Shlyakhto E, Simpson I, Sousa-Uva M, Storey R, Touyz R, Valgimigli M, Vranckx P, Yeh R, Barbato E, Barthélémy O, Bauersachs J, Bhatt D, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale C, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis B, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten F, Sibbing D and Siontis G (2020) 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation, European Heart Journal, 10.1093/eurheartj/ehaa575, 42:14, (1289-1367), Online publication date: 7-Apr-2021. Lopez-Ayala P, Boeddinghaus J, Koechlin L, Nestelberger T and Mueller C (2020) Early Rule-Out Strategies in the Emergency Department Utilizing High-Sensitivity Cardiac Troponin Assays, Clinical Chemistry, 10.1093/clinchem/hvaa226, 67:1, (114-123), Online publication date: 8-Jan-2021. Azar R, Sarkis A and Giannitsis E (2021) A Practical Approach for the Use of High-Sensitivity Cardiac Troponin Assays in the Evaluation of Patients With Chest Pain, The American Journal of Cardiology, 10.1016/j.amjcard.2020.10.037, 139, (1-7), Online publication date: 1-Jan-2021. Kavsak P, Mondoux S, Ma J, Sherbino J, Hill S, Clayton N, Mehta S, Griffith L, McQueen M, Devereaux P and Worster A (2020) Comparison of two biomarker only algorithms for early risk stratification in patients with suspected acute coronary syndrome, International Journal of Cardiology, 10.1016/j.ijcard.2020.06.066, 319, (140-143), Online publication date: 1-Nov-2020. Guedeney P and Collet J (2020) Diagnosis and Management of Acute Coronary Syndrome: What is New and Why? Insight From the 2020 European Society of Cardiology Guidelines, Journal of Clinical Medicine, 10.3390/jcm9113474, 9:11, (3474) Forman D, de Lemos J, Shaw L, Reuben D, Lyubarova R, Peterson E, Spertus J, Zieman S, Salive M and Rich M (2020) Cardiovascular Biomarkers and Imaging in Older Adults, Journal of the American College of Cardiology, 10.1016/j.jacc.2020.07.055, 76:13, (1577-1594), Online publication date: 1-Sep-2020. Nowak R, Christenson R, Jacobsen G, McCord J, Apple F, Singer A, Limkakeng A, Peacock W and deFilippi C (2020) Performance of Novel High-Sensitivity Cardiac Troponin I Assays for 0/1-Hour and 0/2- to 3-Hour Evaluations for Acute Myocardial Infarction: Results From the HIGH-US Study, Annals of Emergency Medicine, 10.1016/j.annemergmed.2019.12.008, 76:1, (1-13), Online publication date: 1-Jul-2020. Vigen R, Diercks D, Hashim I, Pandey A, Zhong L, Kutscher P, Fernandez F, Yu A, Bertulfo B, Molberg K, Metzger J, Soto J, Alzubaidy D, Thibodeaux L, Joglar J, Das S and de Lemos J (2020) Association of a Novel Protocol for Rapid Exclusion of Myocardial Infarction With Resource Use in a US Safety Net Hospital, JAMA Network Open, 10.1001/jamanetworkopen.2020.3359, 3:4, (e203359) Gore M and de Lemos J (2020) Clinical Relevance of the 99th Percentile Upper Reference Limit for High-Sensitivity Cardiac Troponin Assays, Clinical Chemistry, 10.1093/clinchem/hvz038, 66:3, (403-405), Online publication date: 1-Mar-2020. Stepinska J, Lettino M, Ahrens I, Bueno H, Garcia-Castrillo L, Khoury A, Lancellotti P, Mueller C, Muenzel T, Oleksiak A, Petrino R, Guimenez M, Zahger D, Vrints C, Halvorsen S, de Maria E, Lip G, Rossini R, Claeys M and Huber K (2020) Diagnosis and risk stratification of chest pain patients in the emergency department: focus on acute coronary syndromes. A position paper of the Acute Cardiovascular Care Association, European Heart Journal: Acute Cardiovascular Care, 10.1177/2048872619885346, 9:1, (76-89), Online publication date: 1-Feb-2020. Arslan M, Dedic A, Boersma E and Dubois E (2019) Serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and a single high baseline measurement for swift rule-in: A systematic review and meta-analysis, European Heart Journal: Acute Cardiovascular Care, 10.1177/2048872618819421, 9:1, (14-22), Online publication date: 1-Feb-2020. Nestelberger T, Boeddinghaus J, Greenslade J, Parsonage W, Than M, Wussler D, Lopez-Ayala P, Zimmermann T, Meier M, Troester V, Badertscher P, Koechlin L, Wildi K, Anwar M, Freese M, Keller D, Reichlin T, Twerenbold R, Cullen L, Mueller C, Puelacher C, du Fay de Lavallaz J, Rubini Giménez M, Strebel I, Walter J, Huber J, Christ M, Kozhuharov N, Gualandro D, Potlukova E, Baumgartner B, Hafner B, Rentsch K, Miró Ò, Fuenzalida C, Gil B, Martin-Sanchez F, Kawecki D, Geigy N, Meissner K, Kulangara C, López B, Rodriguez Adrada E, Ganovská E, Lohrmann J, Kloos W, Steude J, Buser A, von Eckardstein A, Nowalany-Kozielska E and Muzyk P (2019) Two-Hour Algorithm for Rapid Triage of Suspected Acute Myocardial Infarction Using a High-Sensitivity Cardiac Troponin I Assay, Clinical Chemistry, 10.1373/clinchem.2019.305193, 65:11, (1437-1447), Online publication date: 1-Nov-2019. Nestelberger T, Boeddinghaus J, Wussler D, Twerenbold R, Badertscher P, Wildi K, Miró Ò, López B, Martin-Sanchez F, Muzyk P, Koechlin L, Baumgartner B, Meier M, Troester V, Rubini Giménez M, Puelacher C, du Fay de Lavallaz J, Walter J, Kozhuharov N, Zimmermann T, Gualandro D, Michou E, Potlukova E, Geigy N, Keller D, Reichlin T, Mueller C, Hafner B, Flores D, Meissner K, Kulangara C, Freese M, Osswald S, Stelzig C, Bingisser R, Fuenzalida Inostroza C, Rodríguez Adrada E, Nowalany-Kozielska E, Kawecki D, Parenica J, Ganovská E, Lohrmann J, Amrein M, Steude J, Buser A, Grimm K, Hartmann B, Morawiec B, Rentsch K, von Eckardstein A, Biskup E, Campodarve I and Gea J (2019) Predicting Major Adverse Events in Patients With Acute Myocardial Infarction, Journal of the American College of Cardiology, 10.1016/j.jacc.2019.06.025, 74:7, (842-854), Online publication date: 1-Aug-2019. Januzzi J, Mahler S, Christenson R, Rymer J, Newby L, Body R, Morrow D and Jaffe A (2019) Recommendations for Institutions Transitioning to High-Sensitivity Troponin Testing, Journal of the American College of Cardiology, 10.1016/j.jacc.2018.12.046, 73:9, (1059-1077), Online publication date: 1-Mar-2019. Widimsky P, Crea F, Binder R and Lüscher T (2019) The year in cardiology 2018: acute coronary syndromes, European Heart Journal, 10.1093/eurheartj/ehy904, 40:3, (271-282), Online publication date: 14-Jan-2019. Morawiec B, Przywara-Chowaniec B, Muzyk P, Opara M, Ho L, Tat L, Muller O, Nowalany-Kozielska E and Kawecki D (2018) Combined Use of High-Sensitive Cardiac Troponin, Copeptin, and the Modified HEART Score for Rapid Evaluation of Chest Pain Patients, Disease Markers, 10.1155/2018/9136971, 2018, (1-7), Online publication date: 12-Nov-2018. Chapman A, Hesse K, Andrews J, Ken Lee K, Anand A, Shah A, Sandeman D, Ferry A, Jameson J, Piya S, Stewart S, Marshall L, Strachan F, Gray A, Newby D and Mills N (2018) High-Sensitivity Cardiac Troponin I and Clinical Risk Scores in Patients With Suspected Acute Coronary Syndrome, Circulation, 138:16, (1654-1665), Online publication date: 16-Oct-2018. June 5, 2018Vol 137, Issue 23 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.118.034260PMID: 29866778 Originally publishedJune 5, 2018 Keywordsmyocardial infarctiontroponinPDF download Advertisement SubjectsDiagnostic Testing
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