Validation of a 0/1 h Algorithm for Rapid Diagnosis of Myocardial Infarction Using a High-Sensitivity Troponin I Assay.

Mar 20, 2023

Experts: Jonas Lehmacher,Betül Toprak,Nils Arne Sörensen,Ramona Bei der Kellen,Alina Goßling,Tau Sarra Hartikainen,Paul Michael Haller,Alina Schock,Raphael Twerenbold,Tanja Zeller,Stefan Blankenberg,Dirk Westermann,Johannes Tobias Neumann

Current guidelines recommend 0/1 h algorithms using high-sensitivity cardiac troponin (hs-cTn) for fast diagnosis of myocardial infarction (MI). Yet, for some assays, existing data is limited. We aimed to evaluate the diagnostic performance and the prognostic value of a rapid 0/1 h algorithm for the Access hs-cTnI assay.
In consecutive patients presenting with suspected MI, we measured concentrations of Access hs-cTnI at presentation and after 1 hour. Final diagnosis was adjudicated independently by 2 cardiologists. Parameters for diagnostic performance were calculated, applying the recently derived European Society of Cardiology (ESC) 0/1 h algorithm for Access hs-cTnI. Additionally, we assessed the prognostic utility of Access hs-cTnI for the composite end point of all-cause mortality and incident MI at 3 years.
In 1879 patients, 257 non-ST-elevation MIs occurred. Application of the 0/1 h algorithm classified 44.5% as rule-out, 20.3% as rule-in, and triaged 35.1% to the observe group. High rule-out safety was confirmed with a sensitivity of 97.7% (95% CI, 95.0%-99.1%) and a negative predictive value of 99.3% (95% CI, 98.4%-99.7%). Rule-in capacity was moderate with a specificity of 88.0% (95% CI, 86.3%-89.6%) and a positive predictive value of 50.8% (95% CI, 45.7%-55.9%). After exclusion of patients with ST-elevation MI the results showed strong prognostic value, even after adjustment for cardiovascular risk factors and comorbidities, with adjusted hazard ratios of 2.51 (95% CI, 1.56-4.04) in the observe and 3.55 (95% CI, 2.18-5.79) in the rule-in group for the composite end point of all-cause mortality and incident MI at 3 years, compared to ruled-out patients.
The ESC 0/1 h algorithm for Access hs-cTnI allows safe and efficient triage of patients with suspected MI and has strong prognostic utility up to 3 years after the initial evaluation.

© American Association for Clinical Chemistry 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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ABOUT THE EXPERTS

Jonas Lehmacher,Betül Toprak,Nils Arne Sörensen,Ramona Bei der Kellen,Alina Goßling,Tau Sarra Hartikainen,Paul Michael Haller,Alina Schock,Raphael Twerenbold,Tanja Zeller,Stefan Blankenberg,Dirk Westermann,Johannes Tobias Neumann

Jonas Lehmacher

Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

University Center of Cardiovascular Science, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Hamburg Kiel/Lübeck, Hamburg, Germany.

Betül Toprak

Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

University Center of Cardiovascular Science, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Hamburg Kiel/Lübeck, Hamburg, Germany.

Nils Arne Sörensen

Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

University Center of Cardiovascular Science, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Ramona Bei der Kellen

Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Alina Goßling

Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Tau Sarra Hartikainen

Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Hamburg Kiel/Lübeck, Hamburg, Germany.

Department of Cardiology, University Heart Center Freiburg, Bad Krozingen, Germany.

Paul Michael Haller

Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Hamburg Kiel/Lübeck, Hamburg, Germany.

Alina Schock

Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Raphael Twerenbold

Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

University Center of Cardiovascular Science, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Hamburg Kiel/Lübeck, Hamburg, Germany.

Population Health Research Department, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Tanja Zeller

Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

University Center of Cardiovascular Science, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Hamburg Kiel/Lübeck, Hamburg, Germany.

Stefan Blankenberg

Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

University Center of Cardiovascular Science, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Population Health Research Department, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Dirk Westermann

Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Hamburg Kiel/Lübeck, Hamburg, Germany.

Department of Cardiology, University Heart Center Freiburg, Bad Krozingen, Germany.

Johannes Tobias Neumann

Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

University Center of Cardiovascular Science, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Hamburg Kiel/Lübeck, Hamburg, Germany.

Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.