Direct Comparison of 2 Rule-Out Strategies for Acute Myocardial Infarction: 2-h Accelerated Diagnostic Protocol vs 2-h Algorithm

Clinical Chemistry
Karin WildiChristian Mueller

Abstract

We compared 2 high-sensitivity cardiac troponin (hs-cTn)-based 2-h strategies in patients presenting with suspected acute myocardial infarction (AMI) to the emergency department (ED): the 2-h accelerated diagnostic protocol (2h-ADP) combining hs-cTn, electrocardiogram, and a risk score, and the 2-h algorithm exclusively based on hs-cTn concentrations and their absolute changes. Analyses were performed in 2 independent diagnostic cohorts [European Advantageous Predictors of Acute Coronary Syndrome Evaluation (APACE) study, Australian-New Zealand 2-h Accelerated Diagnostic Protocol to Assess patients with chest Pain symptoms using contemporary Troponins as the only biomarker (ADAPT) study] employing hs-cTnT (Elecsys) and hs-cTnI (Architect). The final diagnosis was adjudicated by 2 independent cardiologists. AMI was the final diagnosis in 16.5% (95% CI, 14.6%-18.6%) of the 1372 patients in APACE, and 12.6% (95% CI, 10.7%-14.7%) of 1153 patients in ADAPT. The negative predictive value (NPV) and sensitivity for AMI were very high and comparable with both strategies using either hs-cTnT or hs-cTnI in both cohorts (all statistical comparisons nonsignificant). The percentage of patients triaged toward rule-out was significantly lower ...Continue Reading

Associated Clinical Trials

References

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Citations

Jun 6, 2018·Circulation·Patrick BadertscherUNKNOWN APACE Investigators
Jul 11, 2019·Circulation. Heart Failure·Peter S PangSean P Collins
Oct 2, 2019·Clinical Chemistry·Thomas NestelbergerUNKNOWN APACE and ADAPT Investigators
Oct 23, 2019·The Journal of Applied Laboratory Medicine·Albert K Y TsuiGeorge Cembrowski
Aug 30, 2020·European Heart Journal·Jean-Philippe ColletUNKNOWN ESC Scientific Document Group
May 26, 2018·Annals of Internal Medicine·Kimon StamatelopoulosKonstantinos Stellos
Feb 27, 2021·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Evangelos GiannitsisKurt Huber
Feb 27, 2021·Clinical Biochemistry·Karin WildiChristian Mueller
Dec 19, 2017·Clinical Biochemistry·Raphael TwerenboldChristian Mueller
Mar 28, 2021·Clinical Biochemistry·Ian L GunsolusLori J Sokoll

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