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Safety and efficacy of the novel esc 0h/1h-protocol for rapid rule-out of myocardial infarction using hs-tni among women and men

Session Poster session 3

Speaker Maria Rubini Gimenez

Event : ESC Congress 2016

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Non-ST-Elevation Myocardial Infarction (NSTEMI)
  • Session type : Poster Session

Authors : M Rubini Gimenez (Basel,CH), R Twerenbold (Basel,CH), K Wildi (Basel,CH), C Puelacher (Basel,CH), J Boeddinghaus (Basel,CH), T Nestelberger (Basel,CH), T Reichlin (Basel,CH), C Mueller (Basel,CH)

M. Rubini Gimenez1 , R. Twerenbold1 , K. Wildi1 , C. Puelacher1 , J. Boeddinghaus1 , T. Nestelberger1 , T. Reichlin1 , C. Mueller1 , 1University Hospital Basel, Department of Cardiology - Basel - Switzerland ,

Infarction acute phase non STEMI

European Heart Journal ( 2016 ) 37 ( Abstract Supplement ), 591

Background: We aimed to prospectively evaluate the safety and efficacy of the new ESC rapid 0h/1h-rule-out protocol for acute myocardial infarction (AMI), among women and men in order to assess potential gender-inequalities.

Methods: We enrolled consecutive patients presenting to the ED with suspected AMI in a prospective international multicenter study. Excluded were patients with ST-segment elevation or no available high sensitive cardiac troponin (hs-cTn) I levels. The final diagnosis was adjudicated by two independent cardiologists. The safety and efficacy of the ESC 0h/1h rule-out protocol, based on LOD (Undetectable levels of hs-cTnI at presentation) in combination with hs-cTnI 1h-algorithm was evaluated. Safety was quantified as the negative predictive value (NPV) for AMI in the rule-out zone. Efficacy was quantified as the percentage of the overall cohort assigned to the rule-out zone.

Results: Among all 1810 patients, 31% were women and 69% men. AMI was the final diagnosis in 18% of patients (16% of women and 19% of men, p=0.050). Using the ESC 0h-1h rule-out protocol achieved a very high safety, with a NPV of 99.4% (95% CI, 97.7–99.9%) among women and 99.1% (95% CI, 98.0–99.7%) among men, p=ns. Regarding efficacy, the ESC strategy classified about 56% of women and 51% of men with suspected AMI (p=0.05) in the rule-out zone.

Conclusions: The current ESC 0h1h-rule-out protocol using the combination of LOD and 1h algorithm hs-cTnI is safe and effective and provides comparable results

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