Details

Autor(en) / Beteiligte

• Wildi, Karin, MD
• Nelles, Berit, MD
• Twerenbold, Raphael, MD
• Giménez, Maria Rubini, MD
• Reichlin, Tobias, MD
• Singeisen, Hélène, MD
• Druey, Sophie, MD
• Haaf, Philip, MD
• Sabti, Zaid, MD
• Hillinger, Petra, MD
• Jaeger, Cedric, MD
• Campodarve, Isabel, MD
• Kreutzinger, Philip, MD
• Puelacher, Christian, MD
• Weidmann, Zoraida Moreno, MD
• Gugala, Mathias, MD
• Pretre, Gilles, MD
• Doerflinger, Stephanie, MS
• Wagener, Max, MD
• Stallone, Fabio, MD
• Freese, Michael, RN
• Stelzig, Claudia, MS
• Rentsch, Katharina, PhD
• Bassetti, Stefano, MD
• Bingisser, Roland, MD
• Osswald, Stefan, MD
• Mueller, Christian, MD

Titel

Safety and Efficacy of the 0 h/3 h-protocol for rapid rule-out of Myocardial Infarction

Ist Teil von

• The American heart journal, 2016-11, Vol.181, p.16-25

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2016

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Background The early and accurate diagnosis of AMI is an important medical and economic challenge. We aimed to prospectively evaluate the performance of the new ESC rapid 0 h/3 h-rule-out protocol for AMI. Methods We enrolled 2727 consecutive patients presenting with suspected AMI without persistent ST-segment elevation to the emergency department in a prospective international multicenter study. The final diagnosis was adjudicated by two independent cardiologists. The performance of the 0 h/3 h-rule-out protocol was evaluated using four high-sensitivity (primary analysis) and three sensitive cardiac troponin (cTn) assays). Results AMI was the final diagnosis in 473 patients (17.3%). Using the four high-sensitivity cTn assays, the 0 h-rule-out protocol correctly ruled-out 99.8% (95%CI, 98.7–100%), 99.6% (95%CI, 98.5–99.9%), 100% (95%CI, 97.9–100%) and 100% (95%CI, 98.0–100%) of late presenters (>6 h from chest pain onset). The 3 h-rule-out protocol correctly ruled-out 99.9% (95%CI, 99.1–100%), 99.5% (95%CI, 98.3–99.9%), 100% (95%CI, 98.1–100%) and 100% (95%CI, 98.2–100%) of early presenters (<6 h from chest pain onset). Using the three sensitive cTn assays, the 0 h-rule-out protocol correctly ruled-out 99.6% (95%CI, 98.6–99.9%), 99.0% (95%CI, 96.9–99.7%) and 99.1% (95%CI, 97.2–99.8%) of late presenters, and the 3 h-rule-out protocol correctly ruled-out 99.4% (95%CI, 98.3–99.8%), 99.2% (95%CI, 97.3–99.8%) and 99.0% (95%CI, 97.2–99.7%) of early presenters. Overall, the 0 h/3 h-rule-out protocol assigned 40–60% of patients to rule-out. None of the patients assigned rule-out died during 3-months follow-up. Conclusions The 0 h/3 h-rule-out protocol seems to allow the accurate rule-out of AMI using both high-sensitivity and sensitive cTn measurements in conjunction with clinical assessment. Additional studies are warranted for external validation.