Immediate rule-out of acute myocardial infarction using electrocardiogram and baseline high-sensitivity troponin I

Johannes Tobias Neumann*, Nils Arne Sörensen, Francisco Ojeda, Tjark Schwemer, Jonas Lehmacher, Saskia Gönner, Nikolas Jarsetz, Till Keller, Sarina Schaefer, Thomas Renné, Ulf Landmesser, Peter Clemmensen, Nataliya Makarova, Renate B. Schnabel, Tanja Zeller, Mahir Karakas, John W. Pickering, Martin Than, William Parsonage, Jaimi Greenslade & 3 others Louise Cullen, Dirk Westermann, Stefan Blankenberg

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

AIMS: Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG) to rule out AMI. METHODS: Troponin I measured with a high-sensitivity assay (hs-TnI) was determined at admission in 1040 patients presenting with suspected AMI (BACC study). To rule out AMI we calculated the negative predictive value (NPV) utilizing the optimal hs-TnI cutoff combined with a low risk ECG. The results were validated in 3566 patients with suspected AMI [2-h Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) studies]. Patients were followed for 6 or 12 months. RESULTS: 184 of all patients were diagnosed with AMI. An hs-TnI cutoff of 3 ng/L resulted in a NPV of 99.3% (CI 97.3-100.0), ruling out 35% of all non-AMI patients. Adding the information of a low riskECGresulted in a 100% (CI 97.5-100.0) NPV (28% ruled out). The 2 validation cohorts replicated the high NPV of this approach. The follow-up mortality in the ruled out population was low (0 deaths in BACC and Stenocardia, 1 death in ADAPT). CONCLUSIONS: A single hs-TnI measurement on admission combined with a low risk ECG appears to rule out AMI safely without need for serial troponin testing. Trial Registration: www.clinicaltrials.gov (NCT02355457).

Original languageEnglish
JournalClinical Chemistry
Volume63
Issue number1
Pages (from-to)394-402
ISSN0009-9147
DOIs
Publication statusPublished - 2017

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Troponin
Troponin I
Electrocardiography
Assays
Biomarkers
Testing

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Neumann, J. T., Sörensen, N. A., Ojeda, F., Schwemer, T., Lehmacher, J., Gönner, S., ... Blankenberg, S. (2017). Immediate rule-out of acute myocardial infarction using electrocardiogram and baseline high-sensitivity troponin I. Clinical Chemistry, 63(1), 394-402. https://doi.org/10.1373/clinchem.2016.262659
Neumann, Johannes Tobias ; Sörensen, Nils Arne ; Ojeda, Francisco ; Schwemer, Tjark ; Lehmacher, Jonas ; Gönner, Saskia ; Jarsetz, Nikolas ; Keller, Till ; Schaefer, Sarina ; Renné, Thomas ; Landmesser, Ulf ; Clemmensen, Peter ; Makarova, Nataliya ; Schnabel, Renate B. ; Zeller, Tanja ; Karakas, Mahir ; Pickering, John W. ; Than, Martin ; Parsonage, William ; Greenslade, Jaimi ; Cullen, Louise ; Westermann, Dirk ; Blankenberg, Stefan. / Immediate rule-out of acute myocardial infarction using electrocardiogram and baseline high-sensitivity troponin I. In: Clinical Chemistry. 2017 ; Vol. 63, No. 1. pp. 394-402.
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title = "Immediate rule-out of acute myocardial infarction using electrocardiogram and baseline high-sensitivity troponin I",
abstract = "AIMS: Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG) to rule out AMI. METHODS: Troponin I measured with a high-sensitivity assay (hs-TnI) was determined at admission in 1040 patients presenting with suspected AMI (BACC study). To rule out AMI we calculated the negative predictive value (NPV) utilizing the optimal hs-TnI cutoff combined with a low risk ECG. The results were validated in 3566 patients with suspected AMI [2-h Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) studies]. Patients were followed for 6 or 12 months. RESULTS: 184 of all patients were diagnosed with AMI. An hs-TnI cutoff of 3 ng/L resulted in a NPV of 99.3{\%} (CI 97.3-100.0), ruling out 35{\%} of all non-AMI patients. Adding the information of a low riskECGresulted in a 100{\%} (CI 97.5-100.0) NPV (28{\%} ruled out). The 2 validation cohorts replicated the high NPV of this approach. The follow-up mortality in the ruled out population was low (0 deaths in BACC and Stenocardia, 1 death in ADAPT). CONCLUSIONS: A single hs-TnI measurement on admission combined with a low risk ECG appears to rule out AMI safely without need for serial troponin testing. Trial Registration: www.clinicaltrials.gov (NCT02355457).",
author = "Neumann, {Johannes Tobias} and S{\"o}rensen, {Nils Arne} and Francisco Ojeda and Tjark Schwemer and Jonas Lehmacher and Saskia G{\"o}nner and Nikolas Jarsetz and Till Keller and Sarina Schaefer and Thomas Renn{\'e} and Ulf Landmesser and Peter Clemmensen and Nataliya Makarova and Schnabel, {Renate B.} and Tanja Zeller and Mahir Karakas and Pickering, {John W.} and Martin Than and William Parsonage and Jaimi Greenslade and Louise Cullen and Dirk Westermann and Stefan Blankenberg",
year = "2017",
doi = "10.1373/clinchem.2016.262659",
language = "English",
volume = "63",
pages = "394--402",
journal = "Clinical Chemistry",
issn = "0009-9147",
publisher = "American Association for Clinical Chemistry, Inc.",
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Neumann, JT, Sörensen, NA, Ojeda, F, Schwemer, T, Lehmacher, J, Gönner, S, Jarsetz, N, Keller, T, Schaefer, S, Renné, T, Landmesser, U, Clemmensen, P, Makarova, N, Schnabel, RB, Zeller, T, Karakas, M, Pickering, JW, Than, M, Parsonage, W, Greenslade, J, Cullen, L, Westermann, D & Blankenberg, S 2017, 'Immediate rule-out of acute myocardial infarction using electrocardiogram and baseline high-sensitivity troponin I', Clinical Chemistry, vol. 63, no. 1, pp. 394-402. https://doi.org/10.1373/clinchem.2016.262659

Immediate rule-out of acute myocardial infarction using electrocardiogram and baseline high-sensitivity troponin I. / Neumann, Johannes Tobias; Sörensen, Nils Arne; Ojeda, Francisco; Schwemer, Tjark; Lehmacher, Jonas; Gönner, Saskia; Jarsetz, Nikolas; Keller, Till; Schaefer, Sarina; Renné, Thomas; Landmesser, Ulf; Clemmensen, Peter; Makarova, Nataliya; Schnabel, Renate B.; Zeller, Tanja; Karakas, Mahir; Pickering, John W.; Than, Martin; Parsonage, William; Greenslade, Jaimi; Cullen, Louise; Westermann, Dirk; Blankenberg, Stefan.

In: Clinical Chemistry, Vol. 63, No. 1, 2017, p. 394-402.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Immediate rule-out of acute myocardial infarction using electrocardiogram and baseline high-sensitivity troponin I

AU - Neumann, Johannes Tobias

AU - Sörensen, Nils Arne

AU - Ojeda, Francisco

AU - Schwemer, Tjark

AU - Lehmacher, Jonas

AU - Gönner, Saskia

AU - Jarsetz, Nikolas

AU - Keller, Till

AU - Schaefer, Sarina

AU - Renné, Thomas

AU - Landmesser, Ulf

AU - Clemmensen, Peter

AU - Makarova, Nataliya

AU - Schnabel, Renate B.

AU - Zeller, Tanja

AU - Karakas, Mahir

AU - Pickering, John W.

AU - Than, Martin

AU - Parsonage, William

AU - Greenslade, Jaimi

AU - Cullen, Louise

AU - Westermann, Dirk

AU - Blankenberg, Stefan

PY - 2017

Y1 - 2017

N2 - AIMS: Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG) to rule out AMI. METHODS: Troponin I measured with a high-sensitivity assay (hs-TnI) was determined at admission in 1040 patients presenting with suspected AMI (BACC study). To rule out AMI we calculated the negative predictive value (NPV) utilizing the optimal hs-TnI cutoff combined with a low risk ECG. The results were validated in 3566 patients with suspected AMI [2-h Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) studies]. Patients were followed for 6 or 12 months. RESULTS: 184 of all patients were diagnosed with AMI. An hs-TnI cutoff of 3 ng/L resulted in a NPV of 99.3% (CI 97.3-100.0), ruling out 35% of all non-AMI patients. Adding the information of a low riskECGresulted in a 100% (CI 97.5-100.0) NPV (28% ruled out). The 2 validation cohorts replicated the high NPV of this approach. The follow-up mortality in the ruled out population was low (0 deaths in BACC and Stenocardia, 1 death in ADAPT). CONCLUSIONS: A single hs-TnI measurement on admission combined with a low risk ECG appears to rule out AMI safely without need for serial troponin testing. Trial Registration: www.clinicaltrials.gov (NCT02355457).

AB - AIMS: Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG) to rule out AMI. METHODS: Troponin I measured with a high-sensitivity assay (hs-TnI) was determined at admission in 1040 patients presenting with suspected AMI (BACC study). To rule out AMI we calculated the negative predictive value (NPV) utilizing the optimal hs-TnI cutoff combined with a low risk ECG. The results were validated in 3566 patients with suspected AMI [2-h Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) studies]. Patients were followed for 6 or 12 months. RESULTS: 184 of all patients were diagnosed with AMI. An hs-TnI cutoff of 3 ng/L resulted in a NPV of 99.3% (CI 97.3-100.0), ruling out 35% of all non-AMI patients. Adding the information of a low riskECGresulted in a 100% (CI 97.5-100.0) NPV (28% ruled out). The 2 validation cohorts replicated the high NPV of this approach. The follow-up mortality in the ruled out population was low (0 deaths in BACC and Stenocardia, 1 death in ADAPT). CONCLUSIONS: A single hs-TnI measurement on admission combined with a low risk ECG appears to rule out AMI safely without need for serial troponin testing. Trial Registration: www.clinicaltrials.gov (NCT02355457).

U2 - 10.1373/clinchem.2016.262659

DO - 10.1373/clinchem.2016.262659

M3 - Journal article

VL - 63

SP - 394

EP - 402

JO - Clinical Chemistry

JF - Clinical Chemistry

SN - 0009-9147

IS - 1

ER -