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

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

doi:10.1001/jamacardio.2016.0695

Cited by 204 publications

(149 citation statements)

References 21 publications

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“…Recent evidences also suggest that the cTn value at presentation combined with a delta of absolute cTn values should be preferable over the use of the percentage variation that was originally proposed (25,27). This approach would enable faster rule, being characterized by a very high negative predictive value (NPV), ranging from 99.6% (31) to 99.8% (48). Interestingly, shorter sampling with HS-cTn immunoassays were found to have almost equal diagnostic accuracy compared to the "standard" 3 h algorithm (48).…”

Section: Hs-ctn In the Ed: Organizational And Economic Aspectsmentioning

confidence: 99%

“…This approach would enable faster rule, being characterized by a very high negative predictive value (NPV), ranging from 99.6% (31) to 99.8% (48). Interestingly, shorter sampling with HS-cTn immunoassays were found to have almost equal diagnostic accuracy compared to the "standard" 3 h algorithm (48). The absolute delta increase of cTn values should however be tailored according to the analytical characteristics of the method, thus always higher than the value characterized by 10% imprecision (8).…”

Section: Hs-ctn In the Ed: Organizational And Economic Aspectsmentioning

confidence: 99%

“…This has been the matter of other studies aimed at identifying better thresholds than the 99th percentile to rule out MI at presentation, prompted by insufficient sensitivity for clinical use of the 99th percentile (50). A lower threshold, set around 5-6 ng/L, has hence been proposed (48,49), as both values are within the 10% total CV of the novel HS-cTnI immunoassay. Shah et al (51) analyzed a cohort of more than 6,300 consecutive patients and found that 56-61% of patients without MI showed cTnI concentrations <5 ng/L, and the NPV for ruling out MI was as high as 99.4-99.6%, remaining consistent across groups stratified by age, sex, risk factors and previous cardiovascular disease.…”

Section: Hs-ctn In the Ed: Organizational And Economic Aspectsmentioning

confidence: 99%

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High-sensitivity cardiac troponin testing in routine practice: economic and organizational advantages

Galli¹,

Lippi

2016

Ann. Transl. Med.

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Very seldom, if ever, a single laboratory test has provided such a paradigm shift in the managed care as cardiac troponin (cTn) testing. More than twenty years of improvements in test design and analytical features have contributed to revolutionize the clinical recommendations and guidelines, and the diagnosis of myocardial infarction (MI) is now highly dependent upon the kinetics of cTn within a suggestive clinical setting. Despite the advent of high-sensitivity cTn (HS-cTn) immunoassays has allowed a more accurate and timely diagnosis as well as a higher prognostic accuracy, the focus is now shifting on the most suitable algorithms and on a comprehensive approach to the clinical management of acute coronary syndrome (ACS). In this article we aim to discuss the implications of HS-cTn testing for ruling out and ruling in ACS. In the latter instance, main improvements are related to ACS diagnosis in women, in whom this pathology is still often underdiagnosed or misdiagnosed. A quick and accurate rule out will also regarded as a great advantage from both an organizational and economic standpoint.The advantages that will stem from this new approach have been recently assessed, and shortening of repeated testing 1 or 2 h from conventional algorithms entailing blood sampling at 3 and 6 h seems attainable. The larger benefits will definitely occur in clinical settings where the actual diagnosis rate of MI among patients with suspect ACS is lower and, consequently, the negative predictive value (NPV) of HS-cTn is the highest.

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Section: Hs-ctn In the Ed: Organizational And Economic Aspectsmentioning

confidence: 99%

Section: Hs-ctn In the Ed: Organizational And Economic Aspectsmentioning

confidence: 99%

Section: Hs-ctn In the Ed: Organizational And Economic Aspectsmentioning

confidence: 99%

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High-sensitivity cardiac troponin testing in routine practice: economic and organizational advantages

Galli¹,

Lippi

2016

Ann. Transl. Med.

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“…To try to reach an acceptable compromise for quickly ruling out and ruling in AMI, diagnostic algorithms using two serial hsTn measurements at ED presentation and after 1 h have been proposed and prospectively validated only for hsTn T [20][21][22]. Accordingly, AMI could be excluded with a negative PV >99% if the admission hsTn T value is <12 ng/L and the absolute 0-1 h δ change is <3 ng/L.…”

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)

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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.

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“…Whereas the interpretation of cardiac troponin levels in the 0 h/3 h algorithm is not substantially different from that of the previous 0 h/6 h algorithm (one value above the 99 th percentile and a rise/fall defined by a delta-change-value), the 0 h/1 h algorithm is based on a different approach ( Figure 3) 18,[65][66][67][68][69][70] .…”

Section: The Interpretation Of Cardiac Troponins In the Era Of High-smentioning

confidence: 99%

Cardiac troponins: State of the (He)Art

Linden¹

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

Abstract: 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.

Cited by 204 publications

References 21 publications

High-sensitivity cardiac troponin testing in routine practice: economic and organizational advantages

High-sensitivity cardiac troponin testing in routine practice: economic and organizational advantages

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

Cardiac troponins: State of the (He)Art

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