title: One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I.
abstract: We aimed to prospectively derive and validate a novel 0-/1-hour algorithm using high-sensitivity cardiac troponin I (hs-cTnI) for the early "rule-out" and "rule-in" of acute myocardial infarction (AMI).
  
  
  METHODS
  In a prospective multicenter diagnostic study, we enrolled 1,500 patients presenting with suspected AMI to the emergency department. The final diagnosis was centrally adjudicated by 2 independent cardiologists blinded to hs-cTnI concentrations. The hs-cTnI (Siemens Vista) 0-/1-hour algorithm incorporated measurements performed at baseline and absolute changes within 1 hour, was derived in the first 750 patients (derivation cohort), and then validated in the second 750 (validation cohort).
  
  
  RESULTS
  Overall, AMI was the final diagnosis in 16% of patients. Applying the hs-cTnI 0-/1-hour algorithm developed in the derivation cohort to the validation cohort, 57% of patients could be classified as "rule-out"; 10%, as "rule-in"; and 33%, as "observe." In the validation cohort, the sensitivity and the negative predictive value for AMI in the "rule-out" zone were 100% (95% CI 96%-100%) and 100% (95% CI 99%-100%), respectively. The specificity and the positive predictive value (PPV) for AMI in the "rule-in" zone were 96% (95% CI 94%-97%) and 70% (95% CI 60%-79%), respectively. Negative predictive value and positive predictive value of the 0-/1-hour algorithm were higher compared to the standard of care combining hs-cTnI with the electrocardiogram (both P < .001).
  
  
  CONCLUSIONS
  The hs-cTnI 0-/1-hour algorithm performs very well for early rule-out as well as rule-in of AMI. The clinical implications are that used in conjunction with all other clinical information, the 0-/1-hour algorithm will be a safe and effective approach to substantially reduce time to diagnosis.
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Cedric
authors.initials: C
authors.lastname: Jaeger
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Karin
authors.initials: K
authors.lastname: Wildi
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Rubini Gimenez
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Neuhaus
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Karin
authors.initials: K
authors.lastname: Grimm
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Jasper
authors.initials: J
authors.lastname: Boeddinghaus
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Petra
authors.initials: P
authors.lastname: Hillinger
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nestelberger
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Helene
authors.initials: H
authors.lastname: Singeisen
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Mathias
authors.initials: M
authors.lastname: Gugala
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Gil
authors.initials: G
authors.lastname: Pretre
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Puelacher
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Max
authors.initials: M
authors.lastname: Wagener
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Ursina
authors.initials: U
authors.lastname: Honegger
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Carmela
authors.initials: C
authors.lastname: Schumacher
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Zoraida
authors.initials: Z
authors.lastname: Moreno Weidmann
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kreutzinger
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Lian
authors.initials: L
authors.lastname: Krivoshei
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Freese
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Claudia
authors.initials: C
authors.lastname: Stelzig
authors.affiliation: Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Dietsche
authors.affiliation: Department of Internal Medicine, Kantonsspital, Olten, Switzerland.
authors.forename: Susanne
authors.initials: S
authors.lastname: Ernst
authors.affiliation: Laboratory Medicine, University Hospital, Basel, Switzerland.
authors.forename: Katharina
authors.initials: K
authors.lastname: Rentsch
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland. Electronic address: Christian.Mueller@usb.ch.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D013997:Time Factors; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I