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Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction
J. Boeddinghaus, T. Nestelberger, R. Twerenbold, JT. Neumann, B. Lindahl, E. Giannitsis, NA. Sörensen, P. Badertscher, JE. Jann, D. Wussler, C. Puelacher, M. Rubini Giménez, K. Wildi, I. Strebel, J. Du Fay de Lavallaz, F. Selman, Z. Sabti, N....
Jazyk angličtina Země Velká Británie
Typ dokumentu časopisecké články, práce podpořená grantem
NLK
Free Medical Journals
od 1996 do Před 1 rokem
Open Access Digital Library
od 1996-01-01
PubMed
30169752
DOI
10.1093/eurheartj/ehy514
Knihovny.cz E-zdroje
- MeSH
- algoritmy MeSH
- časná diagnóza MeSH
- dospělí MeSH
- infarkt myokardu diagnóza epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- troponin krev MeSH
- věkové faktory MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Aims: We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1h-algorithms and to derive and externally validate alternative cut-offs specific to older patients. Methods and results: We prospectively enrolled patients presenting to the emergency department (ED) with symptoms suggestive of acute myocardial infarction in three large diagnostic studies. Final diagnoses were adjudicated by two independent cardiologists. High-sensitivity cardiac troponin (hs-cTn) T and I concentrations were measured at presentation and after 1 h. Patients were stratified according to age [<55 years (young), ≥55 to <70 years (middle-age), ≥70 years (old)]. Rule-out safety of the ESC hs-cTnT 0/1h-algorithm was very high in all age-strata: sensitivity 100% [95% confidence interval (95% CI) 94.9-100] in young, 99.3% (95% CI 96.0-99.9) in middle-age, and 99.3% (95% CI 97.5-99.8) in old patients. Accuracy of rule-in decreased with age: specificity 97.0% (95% CI 95.8-97.9) in young, 96.1% (95% CI 94.5-97.2) in middle-age, and 92.7% (95% CI 90.7-94.3) in older patients. Triage efficacy decreased with increasing age (young 93%, middle-age 80%, old 55%, P < 0.001). Similar results were found for the ESC hs-cTnT 0/1h-algorithm. Alternative, slightly higher cut-off concentrations optimized for older patients maintained very high safety of rule-out, increased specificity of rule-in (P < 0.01), reduced overall efficacy for hs-cTnT (P < 0.01), while maintaining efficacy for hs-cTnI. Findings were confirmed in two validation cohorts (n = 2767). Conclusion: While safety of the ESC 0/1h-algorithms remained very high, increasing age significantly reduced overall efficacy and the accuracy of rule-in. Alternative slightly higher cut-off concentrations may be considered for older patients, particularly if using hs-cTnI. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT00470587, number NCT00470587 and NCT02355457 (BACC).
Emergency Department Kantonsspital Liestal Rheinstrasse 26 Liestal Switzerland
Emergency Department University Hospital Zurich Rämistrasse 100 Zürich Switzerland
Laboratory Medicine University Hospital Basel University of Basel Petersgraben 4 Basel Switzerland
Medizinische Klinik 3 University Heidelberg Im Neuenheimer Feld 410 Heidelberg Germany
Citace poskytuje Crossref.org
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- $a Boeddinghaus, Jasper $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, Basel, Switzerland. Division of Internal Medicine, University Hospital Basel, University of Basel, Petersgraben 4, Basel, Switzerland. GREAT Network, Via Antonio Serra 54, Rome, Italy.
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- $a Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction / $c J. Boeddinghaus, T. Nestelberger, R. Twerenbold, JT. Neumann, B. Lindahl, E. Giannitsis, NA. Sörensen, P. Badertscher, JE. Jann, D. Wussler, C. Puelacher, M. Rubini Giménez, K. Wildi, I. Strebel, J. Du Fay de Lavallaz, F. Selman, Z. Sabti, N. Kozhuharov, E. Potlukova, K. Rentsch, Ò. Miró, FJ. Martin-Sanchez, B. Morawiec, J. Parenica, J. Lohrmann, W. Kloos, A. Buser, N. Geigy, DI. Keller, S. Osswald, T. Reichlin, D. Westermann, S. Blankenberg, C. Mueller, APACE, BACC, and TRAPID-AMI Investigators,
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- $a Aims: We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1h-algorithms and to derive and externally validate alternative cut-offs specific to older patients. Methods and results: We prospectively enrolled patients presenting to the emergency department (ED) with symptoms suggestive of acute myocardial infarction in three large diagnostic studies. Final diagnoses were adjudicated by two independent cardiologists. High-sensitivity cardiac troponin (hs-cTn) T and I concentrations were measured at presentation and after 1 h. Patients were stratified according to age [<55 years (young), ≥55 to <70 years (middle-age), ≥70 years (old)]. Rule-out safety of the ESC hs-cTnT 0/1h-algorithm was very high in all age-strata: sensitivity 100% [95% confidence interval (95% CI) 94.9-100] in young, 99.3% (95% CI 96.0-99.9) in middle-age, and 99.3% (95% CI 97.5-99.8) in old patients. Accuracy of rule-in decreased with age: specificity 97.0% (95% CI 95.8-97.9) in young, 96.1% (95% CI 94.5-97.2) in middle-age, and 92.7% (95% CI 90.7-94.3) in older patients. Triage efficacy decreased with increasing age (young 93%, middle-age 80%, old 55%, P < 0.001). Similar results were found for the ESC hs-cTnT 0/1h-algorithm. Alternative, slightly higher cut-off concentrations optimized for older patients maintained very high safety of rule-out, increased specificity of rule-in (P < 0.01), reduced overall efficacy for hs-cTnT (P < 0.01), while maintaining efficacy for hs-cTnI. Findings were confirmed in two validation cohorts (n = 2767). Conclusion: While safety of the ESC 0/1h-algorithms remained very high, increasing age significantly reduced overall efficacy and the accuracy of rule-in. Alternative slightly higher cut-off concentrations may be considered for older patients, particularly if using hs-cTnI. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT00470587, number NCT00470587 and NCT02355457 (BACC).
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- 700 1_
- $a Nestelberger, Thomas $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, Basel, Switzerland. GREAT Network, Via Antonio Serra 54, Rome, Italy.
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- $a Twerenbold, Raphael $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, Basel, Switzerland. GREAT Network, Via Antonio Serra 54, Rome, Italy. Department of General and Interventional Cardiology, Hamburg University Heart Center, Martinistraße 52, Hamburg, Germany.
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- $a Jann, Janina E $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, Basel, Switzerland. GREAT Network, Via Antonio Serra 54, Rome, Italy.
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