Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T. Mueller, C., Giannitsis, E., Christ, M., Ordóñez-Llanos, J., deFilippi , C., McCord, J., Body, R., Panteghini, M., Jernberg, T., Plebani, M., Verschuren, F., French, J., Christenson, R., Weiser, S., Bendig, G., Dilba, P., Lindahl, B., Twerenbold, R., Katus, H. A., Popp, S., Santalo-Bel, M., Nowak, R. M., Horner, D., Dolci, A., Zaninotto, M., Manara, A., Menassanch-Volker, S., Jarausch, J., & Zaugg, C. Annals of Emergency Medicine, 68(1):76–87.e4, July, 2016.
Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T [link]Paper  doi  abstract   bibtex   
Methods: We enrolled patients presenting with suspected acute myocardial infarction and recent (\textless6 hours) onset of symptoms to the emergency department in a global multicenter diagnostic study. Hs-cTnT (Roche Diagnostics) and sensitive cardiac troponin I (Siemens Healthcare) were measured at presentation and after 1 hour, 2 hours, and 4 to 14 hours in a central laboratory. Patient triage according to the predefined hs-cTnT 0-hour/1-hour algorithm (hs-cTnT below 12 ng/L and D1 hour below 3 ng/L to rule out; hs-cTnT at least 52 ng/L or D1 hour at least 5 ng/L to rule in; remaining patients to the “observational zone”) was compared against a centrally adjudicated final diagnosis by 2 independent cardiologists (reference standard). The final diagnosis was based on all available information, including coronary angiography and echocardiography results, follow-up data, and serial measurements of sensitive cardiac troponin I, whereas adjudicators remained blinded to hs-cTnT. Results: Among 1,282 patients enrolled, acute myocardial infarction was the final diagnosis for 213 (16.6%) patients. Applying the hs-cTnT 0-hour/1-hour algorithm, 813 (63.4%) patients were classified as rule out, 184 (14.4%) were classified as rule in, and 285 (22.2%) were triaged to the observational zone. This resulted in a negative predictive value and sensitivity for acute myocardial infarction of 99.1% (95% confidence interval [CI] 98.2% to 99.7%) and 96.7% (95% CI 93.4% to 98.7%) in the rule-out zone (7 patients with false-negative results), a positive predictive value and specificity for acute myocardial infarction of 77.2% (95% CI 70.4% to 83.0%) and 96.1% (95% CI 94.7% to 97.2%) in the rule-in zone, and a prevalence of acute myocardial infarction of 22.5% in the observational zone. Conclusion: The hs-cTnT 0-hour/1-hour algorithm performs well for early rule-out and rule-in of acute myocardial infarction. [Ann Emerg Med. 2016;68:76-87.]
@article{mueller_multicenter_2016,
	title = {Multicenter {Evaluation} of a 0-{Hour}/1-{Hour} {Algorithm} in the {Diagnosis} of {Myocardial} {Infarction} {With} {High}-{Sensitivity} {Cardiac} {Troponin} {T}},
	volume = {68},
	issn = {01960644},
	url = {http://linkinghub.elsevier.com/retrieve/pii/S0196064415015012},
	doi = {10.1016/j.annemergmed.2015.11.013},
	abstract = {Methods: We enrolled patients presenting with suspected acute myocardial infarction and recent ({\textless}6 hours) onset of symptoms to the emergency department in a global multicenter diagnostic study. Hs-cTnT (Roche Diagnostics) and sensitive cardiac troponin I (Siemens Healthcare) were measured at presentation and after 1 hour, 2 hours, and 4 to 14 hours in a central laboratory. Patient triage according to the predefined hs-cTnT 0-hour/1-hour algorithm (hs-cTnT below 12 ng/L and D1 hour below 3 ng/L to rule out; hs-cTnT at least 52 ng/L or D1 hour at least 5 ng/L to rule in; remaining patients to the “observational zone”) was compared against a centrally adjudicated final diagnosis by 2 independent cardiologists (reference standard). The final diagnosis was based on all available information, including coronary angiography and echocardiography results, follow-up data, and serial measurements of sensitive cardiac troponin I, whereas adjudicators remained blinded to hs-cTnT.
Results: Among 1,282 patients enrolled, acute myocardial infarction was the final diagnosis for 213 (16.6\%) patients. Applying the hs-cTnT 0-hour/1-hour algorithm, 813 (63.4\%) patients were classified as rule out, 184 (14.4\%) were classified as rule in, and 285 (22.2\%) were triaged to the observational zone. This resulted in a negative predictive value and sensitivity for acute myocardial infarction of 99.1\% (95\% confidence interval [CI] 98.2\% to 99.7\%) and 96.7\% (95\% CI 93.4\% to 98.7\%) in the rule-out zone (7 patients with false-negative results), a positive predictive value and specificity for acute myocardial infarction of 77.2\% (95\% CI 70.4\% to 83.0\%) and 96.1\% (95\% CI 94.7\% to 97.2\%) in the rule-in zone, and a prevalence of acute myocardial infarction of 22.5\% in the observational zone.
Conclusion: The hs-cTnT 0-hour/1-hour algorithm performs well for early rule-out and rule-in of acute myocardial infarction. [Ann Emerg Med. 2016;68:76-87.]},
	language = {en},
	number = {1},
	urldate = {2018-03-17TZ},
	journal = {Annals of Emergency Medicine},
	author = {Mueller, Christian and Giannitsis, Evangelos and Christ, Michael and Ordóñez-Llanos, Jorge and deFilippi, Christopher and McCord, James and Body, Richard and Panteghini, Mauro and Jernberg, Tomas and Plebani, Mario and Verschuren, Franck and French, John and Christenson, Robert and Weiser, Silvia and Bendig, Garnet and Dilba, Peter and Lindahl, Bertil and Twerenbold, Raphael and Katus, Hugo A. and Popp, Steffen and Santalo-Bel, Miquel and Nowak, Richard M. and Horner, Daniel and Dolci, Alberto and Zaninotto, Martina and Manara, Alessandro and Menassanch-Volker, Sylvie and Jarausch, Jochen and Zaugg, Christian},
	month = jul,
	year = {2016},
	keywords = {\_tablet},
	pages = {76--87.e4}
}
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