Cargando…

Pre-hospital One-Hour Troponin in a Low-Prevalence Population of Acute Coronary Syndrome: OUT-ACS study

OBJECTIVE: The European Society of Cardiology 0/1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT) has demonstrated high rule-out safety in large hospital validation cohorts. We aimed to validate the algorithm in a primary care setting, where patients have a lower pretest probability...

Descripción completa

Detalles Bibliográficos
Autores principales: Johannessen, Tonje R, Vallersnes, Odd Martin, Halvorsen, Sigrun, Larstorp, Anne Cecilie K., Mdala, Ibrahimu, Atar, Dan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380862/
https://www.ncbi.nlm.nih.gov/pubmed/32719074
http://dx.doi.org/10.1136/openhrt-2020-001296
_version_ 1783562926659993600
author Johannessen, Tonje R
Vallersnes, Odd Martin
Halvorsen, Sigrun
Larstorp, Anne Cecilie K.
Mdala, Ibrahimu
Atar, Dan
author_facet Johannessen, Tonje R
Vallersnes, Odd Martin
Halvorsen, Sigrun
Larstorp, Anne Cecilie K.
Mdala, Ibrahimu
Atar, Dan
author_sort Johannessen, Tonje R
collection PubMed
description OBJECTIVE: The European Society of Cardiology 0/1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT) has demonstrated high rule-out safety in large hospital validation cohorts. We aimed to validate the algorithm in a primary care setting, where patients have a lower pretest probability for acute coronary syndrome. METHODS: This prospective, observational, diagnostic study included patients with acute non-specific chest pain admitted to a primary care emergency clinic in Oslo, Norway, from November 2016 to October 2018. hs-cTnT was measured after 0, 1 and 4 hours. The primary outcome measure was the diagnostic performance of the 0/1-hour algorithm, the 90-day incidence of AMI or all-cause death the secondary. RESULTS: Among 1711 included patients, 61 (3.6%) were diagnosed with AMI. By applying the algorithm, 1311 (76.6%) patients were assigned to the rule-out group. The negative predictive value was 99.9% (95% CI 99.5% to 100.0%), the sensitivity and specificity 98.4% (91.2–100.0) and 79.4% (77.4–81.3), respectively. Sixty-six (3.9%) patients were triaged towards rule-in, where 45 were diagnosed with AMI. The corresponding positive predictive value was 68.2% (58.3–76.7), sensitivity 73.8% (60.9–84.2), and specificity 98.7% (98.1–99.2). Among 334 (19.5%) patients assigned to the observation group in need of further tests, 15 patients had an AMI. The following 90 days, five new patients experienced an AMI and nine patients died, with a low incidence in the rule-out group (0.3%). CONCLUSION: The 0/1-hour algorithm for hs-cTnT seems safe, efficient and applicable for an accelerated assessment of patients with non-specific chest pain in a primary care emergency setting. TRIAL REGISTRATION NUMBER: NCT02983123.
format Online
Article
Text
id pubmed-7380862
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-73808622020-08-04 Pre-hospital One-Hour Troponin in a Low-Prevalence Population of Acute Coronary Syndrome: OUT-ACS study Johannessen, Tonje R Vallersnes, Odd Martin Halvorsen, Sigrun Larstorp, Anne Cecilie K. Mdala, Ibrahimu Atar, Dan Open Heart Coronary Artery Disease OBJECTIVE: The European Society of Cardiology 0/1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT) has demonstrated high rule-out safety in large hospital validation cohorts. We aimed to validate the algorithm in a primary care setting, where patients have a lower pretest probability for acute coronary syndrome. METHODS: This prospective, observational, diagnostic study included patients with acute non-specific chest pain admitted to a primary care emergency clinic in Oslo, Norway, from November 2016 to October 2018. hs-cTnT was measured after 0, 1 and 4 hours. The primary outcome measure was the diagnostic performance of the 0/1-hour algorithm, the 90-day incidence of AMI or all-cause death the secondary. RESULTS: Among 1711 included patients, 61 (3.6%) were diagnosed with AMI. By applying the algorithm, 1311 (76.6%) patients were assigned to the rule-out group. The negative predictive value was 99.9% (95% CI 99.5% to 100.0%), the sensitivity and specificity 98.4% (91.2–100.0) and 79.4% (77.4–81.3), respectively. Sixty-six (3.9%) patients were triaged towards rule-in, where 45 were diagnosed with AMI. The corresponding positive predictive value was 68.2% (58.3–76.7), sensitivity 73.8% (60.9–84.2), and specificity 98.7% (98.1–99.2). Among 334 (19.5%) patients assigned to the observation group in need of further tests, 15 patients had an AMI. The following 90 days, five new patients experienced an AMI and nine patients died, with a low incidence in the rule-out group (0.3%). CONCLUSION: The 0/1-hour algorithm for hs-cTnT seems safe, efficient and applicable for an accelerated assessment of patients with non-specific chest pain in a primary care emergency setting. TRIAL REGISTRATION NUMBER: NCT02983123. BMJ Publishing Group 2020-07-22 /pmc/articles/PMC7380862/ /pubmed/32719074 http://dx.doi.org/10.1136/openhrt-2020-001296 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Coronary Artery Disease
Johannessen, Tonje R
Vallersnes, Odd Martin
Halvorsen, Sigrun
Larstorp, Anne Cecilie K.
Mdala, Ibrahimu
Atar, Dan
Pre-hospital One-Hour Troponin in a Low-Prevalence Population of Acute Coronary Syndrome: OUT-ACS study
title Pre-hospital One-Hour Troponin in a Low-Prevalence Population of Acute Coronary Syndrome: OUT-ACS study
title_full Pre-hospital One-Hour Troponin in a Low-Prevalence Population of Acute Coronary Syndrome: OUT-ACS study
title_fullStr Pre-hospital One-Hour Troponin in a Low-Prevalence Population of Acute Coronary Syndrome: OUT-ACS study
title_full_unstemmed Pre-hospital One-Hour Troponin in a Low-Prevalence Population of Acute Coronary Syndrome: OUT-ACS study
title_short Pre-hospital One-Hour Troponin in a Low-Prevalence Population of Acute Coronary Syndrome: OUT-ACS study
title_sort pre-hospital one-hour troponin in a low-prevalence population of acute coronary syndrome: out-acs study
topic Coronary Artery Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380862/
https://www.ncbi.nlm.nih.gov/pubmed/32719074
http://dx.doi.org/10.1136/openhrt-2020-001296
work_keys_str_mv AT johannessentonjer prehospitalonehourtroponininalowprevalencepopulationofacutecoronarysyndromeoutacsstudy
AT vallersnesoddmartin prehospitalonehourtroponininalowprevalencepopulationofacutecoronarysyndromeoutacsstudy
AT halvorsensigrun prehospitalonehourtroponininalowprevalencepopulationofacutecoronarysyndromeoutacsstudy
AT larstorpannececiliek prehospitalonehourtroponininalowprevalencepopulationofacutecoronarysyndromeoutacsstudy
AT mdalaibrahimu prehospitalonehourtroponininalowprevalencepopulationofacutecoronarysyndromeoutacsstudy
AT atardan prehospitalonehourtroponininalowprevalencepopulationofacutecoronarysyndromeoutacsstudy