Validation of a 0/1 h Algorithm for Rapid Diagnosis of Myocardial Infarction Using a High-Sensitivity Troponin I
Jonas Lehmacher1,2,3, Betül Toprak1,2,3, Nils Arne Sörensen1,2
1Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Insights
The 0/1 hour algorithm using high-sensitivity cardiac troponin (hs-cTn) safely rules out myocardial infarction (MI) and provides prognostic value for patients. This rapid assessment aids in efficient MI diagnosis and long-term risk stratification.
Area of Science:
- Cardiology
- Biomarkers
- Diagnostic Accuracy
Background:
- Current guidelines advocate 0/1 hour algorithms with high-sensitivity cardiac troponin (hs-cTn) for rapid myocardial infarction (MI) diagnosis.
- Limited data exists for certain hs-cTn assays, necessitating further evaluation.
Purpose of the Study:
- To assess the diagnostic performance of the European Society of Cardiology (ESC) 0/1 hour algorithm using the Access hs-cTnI assay.
- To evaluate the prognostic value of the Access hs-cTnI assay for predicting long-term adverse cardiovascular events.
Main Methods:
- Consecutive patients with suspected MI had Access hs-cTnI measured at presentation and 1 hour.
- The ESC 0/1 hour algorithm was applied for MI diagnosis, and diagnostic parameters were calculated.
- Prognostic utility was assessed for the composite endpoint of all-cause mortality and incident MI at 3 years.
Main Results:
- The 0/1 hour algorithm safely ruled out MI in 44.5% of patients (sensitivity 97.7%, NPV 99.3%).
- Rule-in capacity was moderate (specificity 88.0%, PPV 50.8%).
- The assay demonstrated strong 3-year prognostic value for mortality and MI in the observe and rule-in groups, even after risk factor adjustment.
Conclusions:
- The ESC 0/1 hour algorithm with Access hs-cTnI enables safe and efficient triage for suspected MI.
- This approach offers significant prognostic utility for identifying patients at risk for adverse events up to 3 years post-evaluation.
Background:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
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