Early Rule-Out Strategies in the Emergency Department Utilizing High-Sensitivity Cardiac Troponin Assays.

Algorithms Diagnostic Tests, Routine / statistics & numerical data Emergency Service, Hospital Humans Myocardial Infarction / diagnosis Predictive Value of Tests Troponin I / analysis Troponin T / analysis
High-sensitivity cardiac troponin acute myocardial infarction early diagnosis rule-out

Journal

Clinical chemistry
ISSN: 1530-8561
Titre abrégé: Clin Chem
Pays: England
ID NLM: 9421549

Informations de publication

Date de publication:
08 01 2021
Historique:
received: 03 07 2020
accepted: 09 09 2020
pubmed: 7 12 2020
medline: 7 7 2021
entrez: 6 12 2020
Statut: ppublish

Résumé

Over the past decade, intense collaboration between academic investigators and the diagnostic industry have allowed the integration of high-sensitivity cardiac troponin (hs-cTn) assays into clinical practice worldwide. The hs-cTn assays, with their increased diagnostic accuracy for acute myocardial infarction (AMI), have facilitated the maturation of early rule-out strategies. The first iteration was complex and required the combination of a biomarker panel, the electrocardiogram, and a clinical risk score and allowed the safe rule-out of AMI in only 10% of patients with acute chest pain. In contrast, the latest iterations, including the European Society of Cardiology (ESC) 0/1-h algorithm, are simple. They are based on hs-cTn concentrations only and allow the safe rule-out or rule-in of AMI in up to 75% of patients. The purposes of this minireview are (a) to describe the best validated hs-cTn-based strategies for early rule-out of AMI, (b) to discuss the advantages and limitations of the different strategies, (c) to identify patient subgroups requiring particular attention, (d) to recognize challenges for widespread clinical implementation, and (e) to provide guidance on strategies for their safe and effective clinical implementation. Physicians and institutions may choose among several well-validated rule-out algorithms. The ESC 0/1-h algorithm for hs-cTnT or hs-cTnI seems to be the most attractive option today. It best balances safety and efficacy, and it has been derived and validated for all currently available hs-cTnT/I assays, facilitating widespread clinical implementation.

Sections du résumé

BACKGROUND
Over the past decade, intense collaboration between academic investigators and the diagnostic industry have allowed the integration of high-sensitivity cardiac troponin (hs-cTn) assays into clinical practice worldwide. The hs-cTn assays, with their increased diagnostic accuracy for acute myocardial infarction (AMI), have facilitated the maturation of early rule-out strategies. The first iteration was complex and required the combination of a biomarker panel, the electrocardiogram, and a clinical risk score and allowed the safe rule-out of AMI in only 10% of patients with acute chest pain. In contrast, the latest iterations, including the European Society of Cardiology (ESC) 0/1-h algorithm, are simple. They are based on hs-cTn concentrations only and allow the safe rule-out or rule-in of AMI in up to 75% of patients.
CONTENT
The purposes of this minireview are (a) to describe the best validated hs-cTn-based strategies for early rule-out of AMI, (b) to discuss the advantages and limitations of the different strategies, (c) to identify patient subgroups requiring particular attention, (d) to recognize challenges for widespread clinical implementation, and (e) to provide guidance on strategies for their safe and effective clinical implementation.
SUMMARY
Physicians and institutions may choose among several well-validated rule-out algorithms. The ESC 0/1-h algorithm for hs-cTnT or hs-cTnI seems to be the most attractive option today. It best balances safety and efficacy, and it has been derived and validated for all currently available hs-cTnT/I assays, facilitating widespread clinical implementation.

Identifiants

DOI: 10.1093/clinchem/hvaa226 PMID: 33279982
pubmed: 33279982
pii: 6024815
doi: 10.1093/clinchem/hvaa226
doi:

Substances chimiques

Troponin I 0
Troponin T 0

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

114-123

Informations de copyright

© American Association for Clinical Chemistry 2020. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Auteurs

Pedro Lopez-Ayala (P)

Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
GREAT Network, Rome, Italy.

Jasper Boeddinghaus (J)

Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
GREAT Network, Rome, Italy.

Luca Koechlin (L)

Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
GREAT Network, Rome, Italy.
Department of Cardiac Surgery, University Hospital Basel, Switzerland.

Thomas Nestelberger (T)

Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
GREAT Network, Rome, Italy.
Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.

Christian Mueller (C)

Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
GREAT Network, Rome, Italy.

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Classifications MeSH

questionsmedicales.fr › Sciences de l'information › Méthodologies informatiques › Algorithmes › Early Rule-Out Strategies in the Emergency...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Tests diagnostiques courants › Early Rule-Out Strategies in the Emergency...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Administration d'établissement de santé › Administration hospitalière › Services hospitaliers › Service hospitalier d'urgences › Early Rule-Out Strategies in the Emergency...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Early Rule-Out Strategies in the Emergency...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Nécrose › Infarctus › Infarctus du myocarde › Early Rule-Out Strategies in the Emergency...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Méthodologie en recherche épidémiologique › Valeur prédictive des tests › Early Rule-Out Strategies in the Emergency...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Protéines du cytosquelette › Protéines des microfilaments › Troponine › Troponine I › Early Rule-Out Strategies in the Emergency...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Protéines du cytosquelette › Protéines des microfilaments › Troponine › Troponine T › Early Rule-Out Strategies in the Emergency...