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Predicting Major Adverse Events in Patients With Acute Myocardial Infarction.
Journal article

Predicting Major Adverse Events in Patients With Acute Myocardial Infarction.

  • Nestelberger T Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network. Electronic address: https://twitter.com/thomas_nest.
  • Boeddinghaus J Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network; Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland. Electronic address: https://twitter.com/J_Boeddinghaus.
  • Wussler D Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network; Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Twerenbold R Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Badertscher P Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network; Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
  • Wildi K Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network; Critical Care Research Institute, The Prince Charles Hospital, Brisbane and University of Queensland, Brisbane, Queensland, Australia.
  • Miró Ò GREAT Network; Emergency Department, Hospital Clinic, Barcelona, Spain.
  • López B Emergency Department, Hospital Clinic, Barcelona, Spain.
  • Martin-Sanchez FJ GREAT Network; Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain.
  • Muzyk P GREAT Network; 2(nd) Department of Cardiology, School of Medicine with the Division of Dentistry, Zabrze, Medical University of Katowice, Katowice, Poland.
  • Koechlin L Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network; Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Baumgartner B Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Meier M Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Troester V Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Rubini Giménez M Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Puelacher C Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network; Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
  • du Fay de Lavallaz J Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Walter J Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Kozhuharov N Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Zimmermann T Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Gualandro DM Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Michou E Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
  • Potlukova E Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Geigy N Emergency Department, Kantonsspital Baselland, Liestal, Switzerland.
  • Keller DI Emergency Department, University Hospital Zürich, Zürich, Switzerland.
  • Reichlin T GREAT Network; Department of Cardiology, University Hospital Bern, University of Bern, Bern, Switzerland.
  • Mueller C Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network. Electronic address: christian.mueller@usb.ch.
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  • 2019-08-17
Published in:
  • Journal of the American College of Cardiology. - 2019
acute myocardial infarction
clinical assessment
electrocardiography
high-sensitivity cardiac troponin
major adverse cardiac events
Aged
Algorithms
Angina, Unstable
Arrhythmias, Cardiac
Atrioventricular Block
Biomarkers
Electrocardiography
Emergency Service, Hospital
Female
Heart Arrest
Humans
Male
Middle Aged
Myocardial Infarction
Myocardial Revascularization
Predictive Value of Tests
Prospective Studies
Sensitivity and Specificity
Shock, Cardiogenic
Troponin
English BACKGROUND
Early and accurate detection of short-term major adverse cardiac events (MACE) in patients with suspected acute myocardial infarction (AMI) is an unmet clinical need.


OBJECTIVES
The goal of this study was to test the hypothesis that adding clinical judgment and electrocardiogram findings to the European Society of Cardiology (ESC) high-sensitivity cardiac troponin (hs-cTn) measurement at presentation and after 1 h (ESC hs-cTn 0/1 h algorithm) would further improve its performance to predict MACE.


METHODS
Patients presenting to an emergency department with suspected AMI were enrolled in a prospective, multicenter diagnostic study. The primary endpoint was MACE, including all-cause death, cardiac arrest, AMI, cardiogenic shock, sustained ventricular arrhythmia, and high-grade atrioventricular block within 30 days including index events. The secondary endpoint was MACE + unstable angina (UA) receiving early (≤24 h) revascularization.


RESULTS
Among 3,123 patients, the ESC hs-cTnT 0/1 h algorithm triaged significantly more patients toward rule-out compared with the extended algorithm (60%; 95% CI: 59% to 62% vs. 45%; 95% CI: 43% to 46%; p < 0.001), while maintaining similar 30-day MACE rates (0.6%; 95% CI: 0.3% to 1.1% vs. 0.4%; 95% CI: 0.1% to 0.9%; p = 0.429), resulting in a similar negative predictive value (99.4%; 95% CI: 98.9% to 99.6% vs. 99.6%; 95% CI: 99.2% to 99.8%; p = 0.097). The ESC hs-cTnT 0/1 h algorithm ruled-in fewer patients (16%; 95% CI: 14.9% to 17.5% vs. 26%; 95% CI: 24.2% to 27.2%; p < 0.001) compared with the extended algorithm, albeit with a higher positive predictive value (76.6%; 95% CI: 72.8% to 80.1% vs. 59%; 95% CI: 55.5% to 62.3%; p < 0.001). For 30-day MACE + UA, the ESC hs-cTnT 0/1 h algorithm had a higher positive predictive value for rule-in, whereas the extended algorithm had a higher negative predictive value for the rule-out. Similar findings emerged when using hs-cTnI.


CONCLUSIONS
The ESC hs-cTn 0/1 h algorithm better balanced efficacy and safety in the prediction of MACE, whereas the extended algorithm is the preferred option for the rule-out of 30-day MACE + UA. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE]; NCT00470587).
Language
  • English
Open access status
bronze
Identifiers
Persistent URL
https://folia.unifr.ch/global/documents/292928
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