A 3-Hour Diagnostic Algorithm for Non-ST-Elevation Myocardial Infarction Using High-Sensitivity Cardiac Troponin T in Unselected Older Patients Presenting to the Emergency Department

Beitrag in einer Fachzeitschrift


Details zur Publikation

Autorinnen und Autoren: Bahrmann P, Christ M, Bahrmann A, Rittger H, Heppner HJ, Achenbach S, Bertsch T, Sieber C
Zeitschrift: Journal of the American Medical Directors Association
Verlag: ELSEVIER SCIENCE INC
Jahr der Veröffentlichung: 2013
Band: 14
Heftnummer: 6
Seitenbereich: 409-416
ISSN: 1525-8610


Abstract

Objectives: To determine if an algorithm implementing a serial high-sensitive cardiac troponin T (hs-cTnT) measurement at presentation (0h) and at 3 hours after presentation (3h) is helpful for early diagnosis of non-ST-elevation myocardial infarction (NSTEMI) in older patients.Design: Prospective observational cohort study.Setting: An emergency department (ED) of a city hospital covering a population of approximately 1 million in Germany.Participants: A total of 332 consecutive unselected patients were recruited, of whom 25 had one or more of the prespecified exclusion criteria and 1 had a missing hs-cTnT at 3h, resulting in a final population of 306 patients.Measurements: In addition to clinical examination, hs-cTnT was measured at 0h and 3h. The final diagnosis of NSTEMI was adjudicated by two independent consultants and an algorithm for rule-in and rule-out of NSTEMI was developed using classification and regression tree analysis. All patients were followed-up for cardiovascular outcome within 12 months.Results: Among 306 patients (mean age 81 +/- 6 years), 38 (12%) patients had NSTEMI. Accuracy to diagnose NSTEMI was significantly higher for hs-cTnT measurements at 3h versus 0h (area under the receiver operating characteristic curve [AUC] 0.88 vs. 0.82, P = .0038) and for absolute versus relative hs-cTnT delta changes (AUC 0.89 versus 0.69, P < .001). A diagnostic algorithm using hs-cTnT values at presentation and absolute delta changes values ruled-in NSTEMI in 23% and ruled-out NSTEMI in 35% of patients. For patients neither fulfilling the rule-in nor the rule-out criteria, an observational zone was established. Cumulative 1-year survival was 79.4%, 88.5%, and 99.1% in patients classified as rule-in, observational zone, and rule-out, respectively.Conclusion: In older patients, serial hs-cTnT measurements and absolute delta-changes at 3h were valuable for early diagnosis of NSTEMI. An algorithm ruled-in NSTEMI in one quarter of patients with high risk and ruled-out NSTEMI in one-third with low risk. Copyright (c) 2013 - American Medical Directors Association, Inc.


FAU-Autorinnen und Autoren / FAU-Herausgeberinnen und Herausgeber

Achenbach, Stephan Prof. Dr. med.
Medizinische Klinik 2 - Kardiologie, Angiologie
Bahrmann, Philipp PD Dr.
Lehrstuhl für Innere Medizin (Geriatrie)
Heppner, Hans Jürgen PD Dr.
Medizinische Fakultät
Sieber, Cornel Prof. Dr.
Lehrstuhl für Innere Medizin (Geriatrie)


Einrichtungen weiterer Autorinnen und Autoren

Klinikum Nürnberg


Zitierweisen

APA:
Bahrmann, P., Christ, M., Bahrmann, A., Rittger, H., Heppner, H.J., Achenbach, S.,... Sieber, C. (2013). A 3-Hour Diagnostic Algorithm for Non-ST-Elevation Myocardial Infarction Using High-Sensitivity Cardiac Troponin T in Unselected Older Patients Presenting to the Emergency Department. Journal of the American Medical Directors Association, 14(6), 409-416. https://dx.doi.org/10.1016/j.jamda.2012.12.005

MLA:
Bahrmann, Philipp, et al. "A 3-Hour Diagnostic Algorithm for Non-ST-Elevation Myocardial Infarction Using High-Sensitivity Cardiac Troponin T in Unselected Older Patients Presenting to the Emergency Department." Journal of the American Medical Directors Association 14.6 (2013): 409-416.

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Zuletzt aktualisiert 2018-15-10 um 13:08