A 1-h Combination Algorithm Allows Fast Rule-Out and Rule-In of Major Adverse Cardiac Events

Mokhtari, Arash; Borna, Catharina; Gilje, Patrik; Tydén, Patrik; Lindahl, Bertil; Nilsson, Hans-Joergen; Khoshnood, Ardavan; Björk, Jonas; Ekelund, Ulf

doi:10.1016/j.jacc.2016.01.059

Cited by 113 publications

(88 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Mokhtari et al 1 h, combined with ECG findings and history (31) ischemic injury, with the virtual disappearance of unstable angina. Many previous diagnoses of unstable angina have been in fact reclassified as "real" MIs, wherein the improved analytical sensitivity of HS immunoassays have allowed to identify low but clinically significant amounts of cardiac troponins in serum or plasma, which would ultimately mirror the presence of irreversible cardiac injury ( Figure 1).…”

Section: Discussionmentioning

confidence: 99%

“…As a consequence of such a strenuous search of effectiveness, efficiency and safety, a combined algorithm (i.e., combining patient's history, ECG and cardiac troponin testing) has been recently proposed (31). In brief, the Authors suggest rapid rule out when at admission (i.e., 0 h) HS-cardiac troponin T (cTnT) is <12 ng/L, and 1h post admission HS-cTnT shows a delta <3 ng/L, and a non-ischemic ECG has been recorded, and the patient history does not suggest a high risk.…”

Section: G Within 1 H From Chest Pain Onset) the Second Cardiac Trmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic algorithms for acute coronary syndrome—is one better than another?

Cervellin¹,

Mattiuzzi²,

Bovo³

et al. 2016

Annals of Translational Medicine

View full text Add to dashboard Cite

Abstract:The rather short history of diagnostic algorithms for investigating patients with a suspected acute coronary syndrome (ACS) has led to a constantly evolving and unquestionably chaotic scenario. Although the recent development and introduction of high-sensitivity immunoassays for the measurement of cardiac troponins has represented a paradigm shift for dispersing part of the overwhelming fog, many uncertainties remain, especially concerning the appropriate timing for serial testing and the interpretation of cardiac troponin variations over time.Therefore, the aim of this article is to review the available evidence about diagnostic algorithms for ACS which incorporate the measurement of cardiac troponins, and generate a final algorithm attempting to integrate and harmonize the many clinical and laboratory findings emerged from the recent scientific literature.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: G Within 1 H From Chest Pain Onset) the Second Cardiac Trmentioning

confidence: 99%

Diagnostic algorithms for acute coronary syndrome—is one better than another?

Cervellin¹,

Mattiuzzi²,

Bovo³

et al. 2016

Annals of Translational Medicine

View full text Add to dashboard Cite

show abstract

“…The number of HS immunoassays for measuring both cTnI and cTnT is rapidly and constantly increasing, based on the assumption that these methods are analytically superior and may hence allow to accelerate the diagnostic evaluation of patients with suspected ACS, especially using rapid rule-in and rule-out protocols (19,20). Nevertheless, some questions remains.…”

Section: Discussionmentioning

confidence: 99%

Predictive significance of detectable cardiac troponin I measured with a contemporary-sensitive assay in a real life experience

et al. 2016

View full text Add to dashboard Cite

Background: Cardiac troponin (cTn) testing has reduced the likelihood of erroneous discharge of patients with acute coronary syndrome (ACS) from the emergency department (ED), but doubts remain about optimal clinical use. This study was planned for evaluating the predictive significance of cTn values between the limit of detection of the method and the 99th percentile in ED patients evaluated for suspected ACS. Methods:In this retrospective study all hospital records of patients admitted over a 6-month period to the ED and with at least one cTnI value comprised between the limit of detection (0.01 ng/mL) and the 99th percentile of the assay (0.05 ng/mL) were analyzed.Results: A total of 4,749 patients with cTnI value between 0.01-0.05 ng/mL were identified among 57,879 ED visits throughout the study period. Overall, 2,189 patients (46.1%) were discharged from the ED, 2,529 (53.25%) were admitted to the hospital and 31 (0.65%) died during ED stay. A total number of 289 patients out of 2,189 who were discharged (i.e., 13.2%) had additional ED visits within 30 days. Among these, 6 were diagnosed with ACS, representing 0.27% of patients discharged [negative predictive value (NPV) 0.997; 95% CI, 0.994-0.999] and 2.1% of those with second admission (NPV 0.979; 95% CI,. Only one of the 2,529 patients admitted to the hospital (i.e., 0.04%) developed an ACS during hospital stay. Conclusions:The results of our retrospective study suggest that the suitability of using a contemporary-sensitive cTnI immunoassay assay in the context of an appropriate protocol represents a safe and effective strategy for ruling in and ruling out ACS in patients presenting to the ED.

show abstract

“…Adding patient history (no high risk) and electrocardiographic findings (nonischemic changes) may further improve the accuracy of the 0-1 h algorithm to rule-out AMI. This "extended algorithm" has resulted in the rule-out cohort in an incidence of major adverse cardiac events (MACE) at 30 days of 0.5%, becoming 0% when unstable angina was excluded from MACE [28]. In the future, an even lower MACE rate could be obtained by combining the 0-1 h algorithm ruleout power with clinical risk scores, such as HEART [29].…”

Section: The 0-1 H Hstn Protocol To Rule-out (And Rule-in) Amimentioning

confidence: 99%

Fast track protocols using highly sensitive troponin assays for ruling out and ruling in non-ST elevation acute coronary syndrome

Ferraro

Dolci²,

Panteghini³

2017

Clinical Chemistry and Laboratory Medicine (CCLM)

View full text Add to dashboard Cite

Abstract:The introduction of "highly sensitive" cardiac troponin assays (hsTn) has reinforced the evidence that only serial testing incorporated in running algorithms allows a more accurate diagnosis of acute myocardial infarction. In this report, we consider the available evidence supporting the use of fast track protocols for ruling out and ruling in non-ST elevation myocardial infarction (NSTEMI) and compare it with the content of recently released guideline by the European Society of Cardiology, noting some uncomfortable aspects that need urgent clarification and/or revision. Firstly, the guideline drafters have to reconsider the available evidence that does not permit to assign the same class and level of evidence to the very well-validated 0-3 h algorithm and to the 0-1 h algorithm. In agreement with the validity of available data, the limitations of fast track protocols, in particular of the 0-1 h algorithm for NSTEMI rule-in, calls for caution. Secondly, as the current diagnostics guidance by the UK National Institute for Health and Care Excellence recommends, rapid diagnostic protocols should be performed only using well-validated hsTn; recommending the use of an assay before being commercially available is not fair and scientifically sound.

show abstract

A 1-h Combination Algorithm Allows Fast Rule-Out and Rule-In of Major Adverse Cardiac Events

Abstract: 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.

Cited by 113 publications

References 29 publications

Diagnostic algorithms for acute coronary syndrome—is one better than another?

Diagnostic algorithms for acute coronary syndrome—is one better than another?

Predictive significance of detectable cardiac troponin I measured with a contemporary-sensitive assay in a real life experience

Fast track protocols using highly sensitive troponin assays for ruling out and ruling in non-ST elevation acute coronary syndrome

Contact Info

Product

Resources

About