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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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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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. |
format | Online Article Text |
id | pubmed-8003225 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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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