Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F65269705%3A_____%2F18%3A00069077" target="_blank" >RIV/65269705:_____/18:00069077 - isvavai.cz</a>

Alternative codes found

RIV/00216224:14110/18:00104899

Result on the web

<a href="https://academic.oup.com/eurheartj/article/39/42/3780/5086724" target="_blank" >https://academic.oup.com/eurheartj/article/39/42/3780/5086724</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1093/eurheartj/ehy514" target="_blank" >10.1093/eurheartj/ehy514</a>

Result language

angličtina

Original language name

Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction

Original language description

Aims We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1h-algorithms and to derive and externally validate alternative cut-offs specific to older patients. Methods and results We prospectively enrolled patients presenting to the emergency department (ED) with symptoms suggestive of and results acute myocardial infarction in three large diagnostic studies. Final diagnoses were adjudicated by two independent cardiologists. High-sensitivity cardiac troponin (hs-cTn) T and I concentrations were measured at presentation and after 1 h. Patients were stratified according to age [&lt;55 years (young), &gt;= 55 to &lt;70 years (middle-age), &gt;= 70 years (old)]. Rule-out safety of the ESC hs-cTnT 0/1h-algorithm was very high in all age-strata: sensitivity 100% [95% confidence interval (95% CI) 94.9-100] in young, 99.3% (95% CI 96.0-99.9) in middle-age, and 99.3% (95% CI 97.599.8) in old patients. Accuracy of rule-in decreased with age: specificity 97.0% (95% CI 95.8-97.9) in young, 96.1% (95% CI 94.5-97.2) in middle-age, and 92.7% (95% CI 90.7-94.3) in older patients. Triage efficacy decreased with increasing age (young 93%, middle-age 80%, old 55%, P &lt;0.001). Similar results were found for the ESC hs-cTnT 0/1h-algorithm. Alternative, slightly higher cut-off concentrations optimized for older patients maintained very high safety of rule-out, increased specificity of rule-in (P&lt; 0.01), reduced overall efficacy for hs-cTnT (P &lt;0.01), while maintaining efficacy for hs-cTnl. Findings were confirmed in two validation cohorts (n = 2767). Conclusion While safety of the ESC 0/1h-algorithms remained very high, increasing age significantly reduced overall efficacy and the accuracy of rule-in. Alternative slightly higher cut-off concentrations may be considered for older patients, particularly if using hs-cTnl.

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30201 - Cardiac and Cardiovascular systems

Project

—

Continuities

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Publication year

2018

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

European Heart Journal

ISSN

0195-668X

e-ISSN

—

Volume of the periodical

39

Issue of the periodical within the volume

42

Country of publishing house

GB - UNITED KINGDOM

Number of pages

15

Pages from-to

3780-3794

UT code for WoS article

000450054600010

EID of the result in the Scopus database

2-s2.0-85056381112