Evaluation of a 1-hour troponin algorithm for diagnosing myocardial infarction in high-risk patients admitted to a chest pain unit: the prospective FAST-MI cohort study
Objective This study sought to evaluate the diagnostic performance of the 1-hour troponin algorithm for diagnosis of myocardial infarction (MI) without persistent ST-segment elevations (non-ST-segment MI (NSTEMI)) in a cohort with a high prevalence of MI. This algorithm recommend by current guidelin...
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BMJ Publishing Group
2019-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/11/e032124.full |
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| author | Michael Amann Felix Gaiser Sandra Iris Schwenk Faridun Rahimi Roland Schmitz Kambis Mashayekhi Miroslaw Ferenc Franz-Josef Neumann Christian Marc Valina Willibald Hochholzer |
| author_facet | Michael Amann Felix Gaiser Sandra Iris Schwenk Faridun Rahimi Roland Schmitz Kambis Mashayekhi Miroslaw Ferenc Franz-Josef Neumann Christian Marc Valina Willibald Hochholzer |
| author_sort | Michael Amann |
| collection | DOAJ |
| description | Objective This study sought to evaluate the diagnostic performance of the 1-hour troponin algorithm for diagnosis of myocardial infarction (MI) without persistent ST-segment elevations (non-ST-segment MI (NSTEMI)) in a cohort with a high prevalence of MI. This algorithm recommend by current guidelines was previously developed in cohorts with a prevalence of MI of less than 20%.Design Prospective cohort study from November 2015 until December 2016.Setting Dedicated chest pain unit of a single referral centre.Participants Consecutive patients with suspected MI were screened. Patients with subacute symptoms lasting more than 24 hours, new ST-segment elevations at presentation, or an already diagnosed or ruled-out acute MI were excluded. All enrolled patients (n=1317) underwent a full clinical assessment and measurements of high-sensitivity troponin, and were scheduled for an early invasive strategy if clinically indicated.Main outcome measures Final diagnosis of MI according to the Fourth Universal Definition of MI.Results The prevalence of NSTEMI in the present cohort was 36.9%. The sensitivity for rule-out of MI was 99.8%. The specificity for rule-in of MI was found to be 94.3%. However, in 35.7% of patients neither rule-in nor rule-out was possible. In 51.4% of patients diagnosed with MI, a primary non-coronary reason for MI was found (type 2 MI). Different receiver operating characteristic-curve derived cut-offs for troponin and its dynamics did not provide a sufficient differentiation between type 1 and 2 MI for clinical decision making (negative predictive value for rule-out of type 1 MI <70%).Conclusions The 1-hour diagnosis algorithm for patients with suspected NSTEMI can accurately diagnose acute MI in high-risk cohorts. However, discrimination between patients needing an early invasive strategy or not is limited.Trial registration number DRKS00009713. |
| format | Article |
| id | doaj-art-a50323d0f7004fbca633be07f717b372 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-a50323d0f7004fbca633be07f717b3722025-08-20T02:07:24ZengBMJ Publishing GroupBMJ Open2044-60552019-11-0191110.1136/bmjopen-2019-032124Evaluation of a 1-hour troponin algorithm for diagnosing myocardial infarction in high-risk patients admitted to a chest pain unit: the prospective FAST-MI cohort studyMichael Amann0Felix Gaiser1Sandra Iris Schwenk2Faridun Rahimi3Roland Schmitz4Kambis Mashayekhi5Miroslaw Ferenc6Franz-Josef Neumann7Christian Marc Valina8Willibald Hochholzer9Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, GermanyDepartment of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, GermanyDepartment of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, GermanyDepartment of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, GermanyDepartment of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, GermanyDepartment of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, GermanyDepartment of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany1 Department of Cardiology and Angiology II, University Heart Center Freiburg / Bad Krozingen, Bad Krozingen, GermanyDepartment of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, GermanyDepartment of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, GermanyObjective This study sought to evaluate the diagnostic performance of the 1-hour troponin algorithm for diagnosis of myocardial infarction (MI) without persistent ST-segment elevations (non-ST-segment MI (NSTEMI)) in a cohort with a high prevalence of MI. This algorithm recommend by current guidelines was previously developed in cohorts with a prevalence of MI of less than 20%.Design Prospective cohort study from November 2015 until December 2016.Setting Dedicated chest pain unit of a single referral centre.Participants Consecutive patients with suspected MI were screened. Patients with subacute symptoms lasting more than 24 hours, new ST-segment elevations at presentation, or an already diagnosed or ruled-out acute MI were excluded. All enrolled patients (n=1317) underwent a full clinical assessment and measurements of high-sensitivity troponin, and were scheduled for an early invasive strategy if clinically indicated.Main outcome measures Final diagnosis of MI according to the Fourth Universal Definition of MI.Results The prevalence of NSTEMI in the present cohort was 36.9%. The sensitivity for rule-out of MI was 99.8%. The specificity for rule-in of MI was found to be 94.3%. However, in 35.7% of patients neither rule-in nor rule-out was possible. In 51.4% of patients diagnosed with MI, a primary non-coronary reason for MI was found (type 2 MI). Different receiver operating characteristic-curve derived cut-offs for troponin and its dynamics did not provide a sufficient differentiation between type 1 and 2 MI for clinical decision making (negative predictive value for rule-out of type 1 MI <70%).Conclusions The 1-hour diagnosis algorithm for patients with suspected NSTEMI can accurately diagnose acute MI in high-risk cohorts. However, discrimination between patients needing an early invasive strategy or not is limited.Trial registration number DRKS00009713.https://bmjopen.bmj.com/content/9/11/e032124.full |
| spellingShingle | Michael Amann Felix Gaiser Sandra Iris Schwenk Faridun Rahimi Roland Schmitz Kambis Mashayekhi Miroslaw Ferenc Franz-Josef Neumann Christian Marc Valina Willibald Hochholzer Evaluation of a 1-hour troponin algorithm for diagnosing myocardial infarction in high-risk patients admitted to a chest pain unit: the prospective FAST-MI cohort study BMJ Open |
| title | Evaluation of a 1-hour troponin algorithm for diagnosing myocardial infarction in high-risk patients admitted to a chest pain unit: the prospective FAST-MI cohort study |
| title_full | Evaluation of a 1-hour troponin algorithm for diagnosing myocardial infarction in high-risk patients admitted to a chest pain unit: the prospective FAST-MI cohort study |
| title_fullStr | Evaluation of a 1-hour troponin algorithm for diagnosing myocardial infarction in high-risk patients admitted to a chest pain unit: the prospective FAST-MI cohort study |
| title_full_unstemmed | Evaluation of a 1-hour troponin algorithm for diagnosing myocardial infarction in high-risk patients admitted to a chest pain unit: the prospective FAST-MI cohort study |
| title_short | Evaluation of a 1-hour troponin algorithm for diagnosing myocardial infarction in high-risk patients admitted to a chest pain unit: the prospective FAST-MI cohort study |
| title_sort | evaluation of a 1 hour troponin algorithm for diagnosing myocardial infarction in high risk patients admitted to a chest pain unit the prospective fast mi cohort study |
| url | https://bmjopen.bmj.com/content/9/11/e032124.full |
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