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External Validation and Extension of a Clinical Score for the Discrimination of Type 2 Myocardial Infarction

Background: The early non-invasive discrimination of Type 2 versus Type 1 Myocardial Infarction (T2MI, T1MI) is a major unmet clinical need. We aimed to externally validate a recently derived clinical score (Neumann) combing female sex, no radiating chest pain, and high-sensitivity cardiac troponin...

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Autores principales: Nestelberger, Thomas, Lopez-Ayala, Pedro, Boeddinghaus, Jasper, Strebel, Ivo, Rubini Gimenez, Maria, Huber, Iris, Wildi, Karin, Wussler, Desiree, Koechlin, Luca, Prepoudis, Alexandra, Gualandro, Danielle M., Puelacher, Christian, Glarner, Noemi, Haaf, Philip, Frey, Simon, Bakula, Adam, Wick, Rupprecht, Miró, Òscar, Martin-Sanchez, F. Javier, Kawecki, Damian, Keller, Dagmar, Twerenbold, Raphael, Mueller, Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003225/
https://www.ncbi.nlm.nih.gov/pubmed/33803801
http://dx.doi.org/10.3390/jcm10061264
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author Nestelberger, Thomas
Lopez-Ayala, Pedro
Boeddinghaus, Jasper
Strebel, Ivo
Rubini Gimenez, Maria
Huber, Iris
Wildi, Karin
Wussler, Desiree
Koechlin, Luca
Prepoudis, Alexandra
Gualandro, Danielle M.
Puelacher, Christian
Glarner, Noemi
Haaf, Philip
Frey, Simon
Bakula, Adam
Wick, Rupprecht
Miró, Òscar
Martin-Sanchez, F. Javier
Kawecki, Damian
Keller, Dagmar
Twerenbold, Raphael
Mueller, Christian
author_facet Nestelberger, Thomas
Lopez-Ayala, Pedro
Boeddinghaus, Jasper
Strebel, Ivo
Rubini Gimenez, Maria
Huber, Iris
Wildi, Karin
Wussler, Desiree
Koechlin, Luca
Prepoudis, Alexandra
Gualandro, Danielle M.
Puelacher, Christian
Glarner, Noemi
Haaf, Philip
Frey, Simon
Bakula, Adam
Wick, Rupprecht
Miró, Òscar
Martin-Sanchez, F. Javier
Kawecki, Damian
Keller, Dagmar
Twerenbold, Raphael
Mueller, Christian
author_sort Nestelberger, Thomas
collection PubMed
description Background: The early non-invasive discrimination of Type 2 versus Type 1 Myocardial Infarction (T2MI, T1MI) is a major unmet clinical need. We aimed to externally validate a recently derived clinical score (Neumann) combing female sex, no radiating chest pain, and high-sensitivity cardiac troponin I (hs-cTnI) concentration ≤40.8 ng/L. Methods: Patients presenting with acute chest discomfort to the emergency department were prospectively enrolled into an international multicenter diagnostic study. The final diagnoses of T2MI and T1MI were centrally adjudicated by two independent cardiologists using all information including cardiac imaging and serial measurements of hs-cTnT/I according to the fourth universal definition of MI. Model performance for T2MI diagnosis was assessed by formal tests and graphical means of discrimination and calibration. Results: Among 6684 enrolled patients, MI was the adjudicated final diagnosis in 1079 (19%) patients, of which 242 (22%) had T2MI. External validation of the Neumann Score showed a moderate discrimination (C-statistic 0.67 (95%CI 0.64–0.71)). Model calibration showed underestimation of the predicted probabilities of having T2MI for low point scores. Model extension by adding the binary variable heart rate >120/min significantly improved model performance (C-statistic 0.73 (95% CI 0.70–0.76, p < 0.001) and had good calibration. Patients with the highest score values of 3 (Neumann Score, 9.9%) and 5 (Extended Neumann Score, 3.3%) had a 53% and 91% predicted probability of T2MI, respectively. Conclusion: The Neumann Score provided moderate discrimination and suboptimal calibration. Extending the Neumann Score by adding heart rate >120/min improved the model’s performance.
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spelling pubmed-80032252021-03-28 External Validation and Extension of a Clinical Score for the Discrimination of Type 2 Myocardial Infarction Nestelberger, Thomas Lopez-Ayala, Pedro Boeddinghaus, Jasper Strebel, Ivo Rubini Gimenez, Maria Huber, Iris Wildi, Karin Wussler, Desiree Koechlin, Luca Prepoudis, Alexandra Gualandro, Danielle M. Puelacher, Christian Glarner, Noemi Haaf, Philip Frey, Simon Bakula, Adam Wick, Rupprecht Miró, Òscar Martin-Sanchez, F. Javier Kawecki, Damian Keller, Dagmar Twerenbold, Raphael Mueller, Christian J Clin Med Article Background: The early non-invasive discrimination of Type 2 versus Type 1 Myocardial Infarction (T2MI, T1MI) is a major unmet clinical need. We aimed to externally validate a recently derived clinical score (Neumann) combing female sex, no radiating chest pain, and high-sensitivity cardiac troponin I (hs-cTnI) concentration ≤40.8 ng/L. Methods: Patients presenting with acute chest discomfort to the emergency department were prospectively enrolled into an international multicenter diagnostic study. The final diagnoses of T2MI and T1MI were centrally adjudicated by two independent cardiologists using all information including cardiac imaging and serial measurements of hs-cTnT/I according to the fourth universal definition of MI. Model performance for T2MI diagnosis was assessed by formal tests and graphical means of discrimination and calibration. Results: Among 6684 enrolled patients, MI was the adjudicated final diagnosis in 1079 (19%) patients, of which 242 (22%) had T2MI. External validation of the Neumann Score showed a moderate discrimination (C-statistic 0.67 (95%CI 0.64–0.71)). Model calibration showed underestimation of the predicted probabilities of having T2MI for low point scores. Model extension by adding the binary variable heart rate >120/min significantly improved model performance (C-statistic 0.73 (95% CI 0.70–0.76, p < 0.001) and had good calibration. Patients with the highest score values of 3 (Neumann Score, 9.9%) and 5 (Extended Neumann Score, 3.3%) had a 53% and 91% predicted probability of T2MI, respectively. Conclusion: The Neumann Score provided moderate discrimination and suboptimal calibration. Extending the Neumann Score by adding heart rate >120/min improved the model’s performance. MDPI 2021-03-18 /pmc/articles/PMC8003225/ /pubmed/33803801 http://dx.doi.org/10.3390/jcm10061264 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Nestelberger, Thomas
Lopez-Ayala, Pedro
Boeddinghaus, Jasper
Strebel, Ivo
Rubini Gimenez, Maria
Huber, Iris
Wildi, Karin
Wussler, Desiree
Koechlin, Luca
Prepoudis, Alexandra
Gualandro, Danielle M.
Puelacher, Christian
Glarner, Noemi
Haaf, Philip
Frey, Simon
Bakula, Adam
Wick, Rupprecht
Miró, Òscar
Martin-Sanchez, F. Javier
Kawecki, Damian
Keller, Dagmar
Twerenbold, Raphael
Mueller, Christian
External Validation and Extension of a Clinical Score for the Discrimination of Type 2 Myocardial Infarction
title External Validation and Extension of a Clinical Score for the Discrimination of Type 2 Myocardial Infarction
title_full External Validation and Extension of a Clinical Score for the Discrimination of Type 2 Myocardial Infarction
title_fullStr External Validation and Extension of a Clinical Score for the Discrimination of Type 2 Myocardial Infarction
title_full_unstemmed External Validation and Extension of a Clinical Score for the Discrimination of Type 2 Myocardial Infarction
title_short External Validation and Extension of a Clinical Score for the Discrimination of Type 2 Myocardial Infarction
title_sort external validation and extension of a clinical score for the discrimination of type 2 myocardial infarction
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003225/
https://www.ncbi.nlm.nih.gov/pubmed/33803801
http://dx.doi.org/10.3390/jcm10061264
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