1. Novel Criteria for the Observe-Zone of the ESC 0/1h-hs-cTnT Algorithm
- Author
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Pedro Lopez-Ayala, Thomas Nestelberger, Jasper Boeddinghaus, Luca Koechlin, Paul David Ratmann, Ivo Strebel, Juliane Gehrke, Severin Meier, Joan Walter, Maria Rubini Gimenez, Eugenio Mutschler, Òscar Miró, Beatriz López-Barbeito, Francisco Javier Martín-Sánchez, Esther Rodríguez-Adrada, Dagmar I. Keller, L. Kristin Newby, Raphael Twerenbold, Evangelos Giannitsis, Bertil Lindahl, Christian Mueller, Tobias Zimmermann, Hadrien Schoepfer, Tania Coscia, Valentina Troester, Tobias Reichlin, Marina Kaeslin, Michael Christ, Mario Meier, Patrick Badertscher, Christian Puelacher, Jeanne du Fay de Lavallaz, Eliska Potlukova, Damian Kawecki, Nicolas Geigy, Katharina Rentsch, Samyut Shrestha, Beata Morawiec, Piotr Munzk, Tobias Breidthardt, Michael Freese, Gemma Martinez-Nadal, Carolina Fuenzalida, Sofia Calderón, Esther Rodriguez Adrada, Eva Ganovská, Jiri Parenica, Arnold von Eckardstein, Isabel Campodarve, Joachim Gea, James Mccord, Richard Nowak, Richard Body, Christopher R. deFilippi, Robert H. Christenson, Mauro Panteghini, Mario Plebani, Franck Verschuren, John French, Silvia Weiser, and Tomas Jernberg
- Subjects
medicine.medical_specialty ,Cardiac troponin ,algorithms ,Cardiology ,Myocardial Infarction ,Cardiovascular System ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,In patient ,Myocardial infarction ,troponin T ,biomarkers ,troponin ,biology ,Troponin T ,business.industry ,Diagnostic Tests, Routine ,Data Collection ,myocardial infarction ,Heart ,medicine.disease ,Troponin ,Cardiac Imaging Techniques ,triage ,biology.protein ,ST Elevation Myocardial Infarction ,NSTEMI ,Cardiology and Cardiovascular Medicine ,business ,Algorithms - Abstract
Background: The non–ST-segment–elevation myocardial infarction (NSTEMI) guidelines of the European Society of Cardiology (ESC) recommend a 3h cardiac troponin determination in patients triaged to the observe-zone of the ESC 0/1h-algorithm; however, no specific cutoff for further triage is endorsed. Recently, a specific cutoff for 0/3h high-sensitivity cardiac troponin T (hs-cTnT) change (7 ng/L) was proposed, warranting external validation. Methods: Patients presenting with acute chest discomfort to the emergency department were prospectively enrolled into an international multicenter diagnostic study. Final diagnoses were centrally adjudicated by 2 independent cardiologists applying the fourth universal definition of myocardial infarction, on the basis of complete cardiac workup, cardiac imaging, and serial hs-cTnT. Hs-cTnT concentrations were measured at presentation, after 1 hour, and after 3 hours. The objective was to externally validate the proposed cutoff, and if necessary, derive and internally as well as externally validate novel 0/3h-criteria for the observe-zone of the ESC 0/1h-hs-cTnT-algorithm in an independent multicenter cohort. Results: Among 2076 eligible patients, application of the ESC 0/1h-hs-cTnT-algorithm triaged 1512 patients (72.8%) to either rule out or rule in NSTEMI, leaving 564 patients (27.2%) in the observe-zone (adjudicated NSTEMI prevalence, 120/564 patients, 21.3%). The suggested 0/3h-hs-cTnT-change of Conclusions: A combination of a 3h-hs-cTnT concentration ( Registration: URL: https://clinicaltrials.gov ; Unique identifier: NCT00470587.
- Published
- 2021