Abstract 16833: Immediate Rule-out of Acute Myocardial Infarction Using Electrocardiogram and Baseline High-sensitivity Troponin I
Abstract 16833: Immediate Rule-out of Acute Myocardial Infarction Using Electrocardiogram and Baseline High-sensitivity Troponin I
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摘要 16833：使用心电图和基线高敏肌钙蛋白 I 立即排除急性心肌梗塞
作者：
J. Neumann;N. Sörensen;F. Ojeda;T. Schwemer;T. Keller;T. Renné;U. Landmesser;P. Clemmensen;R. Schnabel;T. Zeller;M. Karakas;M. Than;W. Parsonage;J. Greenslade;L. Cullen;S. Blankenberg;D. Westermann
背景：当前指南建议使用 3 小时或 1 小时算法进行连续肌钙蛋白测量，以排除急性心肌梗死 (AMI)。在本研究中，我们评估了入院时直接进行单次高敏肌钙蛋白 I (hs-TnI) 测量与非缺血性心电图相结合以排除 AMI 的诊断性能。方法：我们测量了 1,216 名疑似 AMI 患者的基线 hs-TnI。 ST 段抬高 AMI 患者被排除在进一步分析之外 (n=60)。评估不同的 hs-TnI 截止浓度并结合非缺血心电图信息。我们计算了阴性预测值 (NPV) 以排除 AMI。所有患者均接受长达 2 年的随访。结果在 2 个独立的 3,566 名疑似 AMI 患者队列中得到验证。结果：我们研究人群的平均年龄为 64 岁，中位随访时间为 525 天。 216 名患者被诊断为非 ST 段抬高 AMI。应用 3 ng/L 的基线 hs-TnI 截止浓度导致 NPV 为 99.4%。额外应用非缺血性心电图后，NPV 增加至 100%。这意味着 21% 的患者立即被排除。 12 个月后，该排除人群的死亡率为 0%。 2 个独立队列验证了该方法的高 NPV（NPV 100% 和 99.8%）。结论：应用基线 hs-TnI 截止浓度 3 ng/L 结合非缺血性心电图可安全排除 AMI，无需进行系列肌钙蛋白检测。
Background: Current guidelines recommend serial troponin measurements using a 3-hour or 1-hour algorithm to rule-out acute myocardial infarction (AMI). In this study we evaluate the diagnostic performance of a single high-sensitivity troponin I (hs-TnI) measurement combined with a non-ischaemic ECG directly at admission to exclude AMI. Methods: We measured baseline hs-TnI in 1,216 patients with suspected AMI. Patients with ST-elevation AMI were exlcuded from further analyses (n=60). Different hs-TnI cutoff concentrations were evaluated and combined with the information of a non-ischaemic ECG. We calculated the negative predictive value (NPV) to exclude AMI. All patients were followed for up to 2 years. The results were validated in 2 independent cohorts of patients with suspected AMI in 3,566 patients. Results: The mean age of our study population was 64 years, the median follow-up time was 525 days. 216 patients were diagnosed with non-ST-elevation AMI. Application of a baseline hs-TnI cutoff concentration of 3 ng/L resulted in a NPV of 99.4%. After additional application of a non-ischaemic ECG, the NPV increased to 100%. This translated into immediate rule-out of 21% of all patients. The mortality rate in this rule-out population was 0% after 12 months. 2 independent cohorts validated the high NPV of this approach (NPV 100% and 99.8%). Conclusion: Application of a baseline hs-TnI cutoff concentration of 3 ng/L combined with a non-ischaemic ECG excluded AMI safely without need for serial troponin testing.