Trial reportCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2015
Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay.
4 registry-linked trialsOpen access · goldAbstract readClinical TrialMulticenter StudyValidation Study
In one paragraph
Trial report in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 56 papers, 2 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
56citing papers in PubMed, 2 pooled it
23.6field-weighted citation impact, top 1% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Advantageous Predictors of Acute Coronary Syndromes Evaluation (APACE) Study
Prospective RandOmised Trial of Emergency Cardiac CT
Rapid Use of High-sensitive Cardiac Troponin I for ruling-in and Ruling-out of Acute Myocardial Infarction
Early Cardiac Magnetic Resonance Imaging in Suspected Non-ST-Elevation Myocardial Infarction: An Observational Two-Center Study
Who cites it
56 citing papers in PubMed, 2 syntheses or guidelines pooled it, 225 citations in OpenAlex.
- High-sensitivity troponin assays for early rule-out of acute myocardial infarction in people with acute chest pain: a systematic review and economic evaluation.Health technology assessment (Winchester, England) · 2021Pooled it
- Serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and a single high baseline measurement for swift rule-in: A systematic review and meta-analysis.European heart journal. Acute cardiovascular care · 2020Pooled it
- Diagnostic performance of the Myocardial-Ischaemic-Injury index machine-learning algorithm in patients with an initial indeterminate troponin.Open heart · 2026Trial
- High-Sensitivity Cardiac Troponin T Improves the Diagnosis of Perioperative MI.Anesthesia and analgesia · 2017Trial
- Providing Rapid Out of Hospital Acute Cardiovascular Treatment 4 (PROACT-4).Journal of the American Heart Association · 2015Trial
- The Evolution of Accelerated Diagnostic Protocols for Suspected Myocardial Infarction.Journal of clinical medicine · 2026Review
- Article
- Revisiting High-Sensitivity Cardiac Troponin Abnormal Baseline Cutoffs: Implications for AMI Diagnosis in the Emergency Department.Journal of clinical medicine · 2025Article
- Estimation of Cardiac Troponin-T Levels in Acute Myocardial Infarction With Reference to Short-Term Prognosis.Cureus · 2025Article
- The diagnostic accuracy of the ESC 0/1-hour algorithm in non-ST-segment elevation myocardial infarction in a crowded emergency department: a real-world experience from a single-center in Türkiye.BMC emergency medicine · 2025Article
- Rapid rule-out of acute myocardial infarction using the 0/1-hour algorithm for cardiac troponins in emergency primary care: the OUT-ACS implementation study.BMC primary care · 2025Article
- Coronary computed tomography angiography improves assessment of patients with acute chest pain and inconclusively elevated high-sensitivity troponins.European radiology · 2025Observational
- Interpretation of elevated baseline concentrations and serial changes of high-sensitivity cardiac troponin T in confirmed muscular dystrophies.ESC heart failure · 2024Article
- Article
- Association of accompanying dyspnoea with diagnosis and outcome of patients presenting with acute chest discomfort.European heart journal. Acute cardiovascular care · 2023Article
- Serial high-sensitivity cardiac troponin testing for the diagnosis of myocardial infarction: a scoping review.BMJ open · 2022Article
- Current and Future Applications of Artificial Intelligence in Coronary Artery Disease.Healthcare (Basel, Switzerland) · 2022Review
- Contemporary Risk Stratification of Acute Coronary Syndrome.US cardiology · 2022Review
- Article
- Implementing an early rule-out pathway for acute myocardial infarction in clinical practice.Heart (British Cardiac Society) · 2021Review
Corrections and comments
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Authors and funding
29 authors at 4 institutions in 2 countries.
Tobias ReichlinDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Raphael TwerenboldDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Karin WildiDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Maria Rubini GimenezDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Nathalie BergsmaDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Philip HaafDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Sophie DrueyDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Christian PuelacherDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Berit MoehringDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Michael FreeseDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Claudia StelzigDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Lian KrivosheiDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Petra HillingerDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Cedric JägerDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Thomas HerrmannDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Philip KreutzingerDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Milos RadosavacDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Zoraida Moreno WeidmannDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Kateryna PershynaDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Ursina HoneggerDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Max WagenerDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Thierry VuillomenetDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Isabel CampodarveDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Roland BingisserDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Òscar MiróDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Katharina RentschDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Stefano BassettiDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Stefan OsswaldDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland.
Christian MuellerDepartment of Cardiology and Cardiovascular Research Institute Basel (Reichlin, Twerenbold, Wildi, Rubini Gimenez, Bergsma, Haaf, Druey, Puelacher, Moehring, Freese, Stelzig, Krivoshei, Hillinger, Jäger, Herrmann, Kreutzinger, Radosavac, Weidmann, Pershyna, Honegger, Wagener, Vuillomenet, Osswald, Mueller), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Rubini Gimenez, Campodarve), Internal Medicine Department, Hospital del Mar - Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Emergency Department (Bingisser), Universitätsspital Basel, Basel, Switzerland; Emergency Department (Miró), Hospital Clínic de Barcelona, Barcelona, Spain; Laboratory Medicine (Rentsch), Universitätsspital Basel, Basel, Switzerland; Kantonsspital Olten (Bassetti), Olten, Switzerland chmueller@uhbs.ch.
Hospital Del Mar · ESUniversity Hospital of Basel · CHHospital Clínic de Barcelona · ESKantonsschule Olten · CH
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWe aimed to prospectively validate a novel 1-hour algorithm using high-sensitivity cardiac troponin T measurement for early rule-out and rule-in of acute myocardial infarction (MI).
methodsIn a multicentre study, we enrolled 1320 patients presenting to the emergency department with suspected acute MI. The high-sensitivity cardiac troponin T 1-hour algorithm, incorporating baseline values as well as absolute changes within the first hour, was validated against the final diagnosis. The final diagnosis was then adjudicated by 2 independent cardiologists using all available information, including coronary angiography, echocardiography, follow-up data and serial measurements of high-sensitivity cardiac troponin T levels.
resultsAcute MI was the final diagnosis in 17.3% of patients. With application of the high-sensitivity cardiac troponin T 1-hour algorithm, 786 (59.5%) patients were classified as "rule-out," 216 (16.4%) were classified as "rule-in" and 318 (24.1%) were classified to the "observational zone." The sensitivity and the negative predictive value for acute MI in the rule-out zone were 99.6% (95% confidence interval [CI] 97.6%-99.9%) and 99.9% (95% CI 99.3%-100%), respectively. The specificity and the positive predictive value for acute MI in the rule-in zone were 95.7% (95% CI 94.3%-96.8%) and 78.2% (95% CI 72.1%-83.6%), respectively. The 1-hour algorithm provided higher negative and positive predictive values than the standard interpretation of highsensitivity cardiac troponin T using a single cut-off level (both p < 0.05). Cumulative 30-day mortality was 0.0%, 1.6% and 1.9% in patients classified in the rule-out, observational and rule-in groups, respectively (p = 0.001).
interpretationThis rapid strategy incorporating high-sensitivity cardiac troponin T baseline values and absolute changes within the first hour substantially accelerated the management of suspected acute MI by allowing safe rule-out as well as accurate rule-in of acute MI in 3 out of 4 patients.
trial registrationClinicalTrials.gov, NCT00470587.
Indexed as
AgedAged, 80 and overAlgorithmsBiomarkersDecision Support TechniquesElectrocardiographyFemaleHumansMaleMiddle AgedMyocardial InfarctionProspective StudiesTroponin TBiomarkersTroponin T
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Registered trials
NCT00470587ClinicalTrials.gov
NCT03583320ClinicalTrials.gov
NCT03634384ClinicalTrials.gov
NCT04140019ClinicalTrials.gov
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