1. 0/2 h-Algorithm for Rapid Triage of Suspected Myocardial Infarction Using a Novel High-Sensitivity Cardiac Troponin I Assay
- Author
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Carolina Mitrovic, Esther Rodriguez Calderón, Tobias Munzk, Joaquim Campodarve, Maria Rubini Gimenez, Thomas Nestelberger, F. Javier Martín-Sánchez, Sandra Rentsch, Gea, Luca Koechlin, Michael Christ, Christian Zimmermann, Christian Mueller, Bernhard Okamura, Gemma Martínez-Nadal, Eva Adrada, Noemi Fuenzalida, Jiri Ganovská, Katharina Geigy, Desiree Wussler, Sofia López, Eliska du Fay de Lavallaz, Jeanne Puelacher, Pedro Lopez-Ayala, Karin Wildi, Dagmar I. Keller, Michael Breidthardt, Ana Yufera Sanchez, Matthias Potlukova, Nicolas Diebold, Beata Morawiec Piotr Glarner, Adam Strebel, Simon Bakula, Arnold Parenica, Beatriz Freese, Damian Kawecki, Isabel von Eckardstein, Òscar Miró, Danielle M Frey, Jasper Boeddinghaus, Samyut Shrestha, Jennifer Rohner, Tobias Gualandro, and Raphael Twerenbold
- Subjects
medicine.medical_specialty ,Cardiac troponin ,business.industry ,Internal medicine ,Biochemistry (medical) ,Clinical Biochemistry ,medicine ,Cardiology ,Myocardial infarction ,Sensitivity (control systems) ,medicine.disease ,business ,Triage - Abstract
Background We aimed to derive and validate a 0/2 h-algorithm using the new high-sensitivity cardiac troponin I (hs-cTnI)-VITROS assay (VITROS® Immunodiagnostic Products hs-Troponin I Reagent Pack, Ortho Clinical Diagnostics) for rapid rule-out/in of non-ST-segment elevation myocardial infarction (NSTEMI). Methods The final diagnosis was centrally adjudicated by 2 independent cardiologists according to the fourth universal definition of myocardial infarction (MI) among 1888 patients presenting to the emergency department with acute chest pain. hs-cTnI-VITROS concentrations were measured at presentation and at 2 h in a blinded fashion. The optimal assay-specific thresholds for the hs-cTnI-VITROS 0/2 h-algorithm were derived in a randomly selected 70% of the cohort and validated in the remaining 30%. Results NSTEMI was the final diagnosis in 216/1322 (16.3%) patients of the derivation cohort. Rule-out was defined as baseline hs-cTnI concentrations of 3 h or a baseline hs-cTnI concentration of Conclusion hs-cTnI-VITROS concentrations at presentation combined with absolute changes within the first 2 h allowed safe rule-out and accurate rule-in of NSTEMI in two-thirds of unselected patients presenting with acute chest pain to the emergency department. Trial registration www.clinicaltrials.gov: NCT0047058
- Published
- 2021