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

Jasper Boeddinghaus; Thomas Nestelberger; Raphael Twerenbold; Johannes Tobias Neumann; Bertil Lindahl; Evangelos Giannitsis; Nils Arne Sorensen; Patrick Badertscher; Janina E. Jann; Desiree Wussler; Christian Puelacher; Maria Rubini Gimenez; Karin Wildi; Ivo Strebel; Jeanne Du Fay de Lavallaz; Farah Selman; Zaid Sabti; Nikola Kozhuharov; Eliska Potlukova; Katharina Rentsch; Oscar Miro; F. Javier Martin-Sanchez; Beata Morawiec; Jiri Parenica; Jens Lohrmann; Wanda Kloos; Andreas Buser; Nicolas Geigy; Dagmar I. Keller; Stefan Osswald; Tobias Reichlin; Dirk Westermann; Stefan Blankenberg; Christian Mueller; Samyut Shrestha; Dayana Flores; Michael Freese; Claudia Stelzig; Caroline Kulangara; Kathrin Meissner; Nicolas Schaerli; Deborah Mueller; Lorraine Sazgary; Stella Marbot; Beatriz Lopez; Sofia Calderon; Esther Rodriguez Adrada; Damian Kawecki; Ewa Nowalany-Kozielska; Eva Ganovska; Arnold Von Eckardstein; Isabel Campodarve; Michael Christ; Jorge Ordonez-Llanos; Christopher R. De Filippi; James McCord; Richard Body; Mauro Panteghini; Thomas Jernberg; Mario Plebani; Franck Verschuren; John K. French; Robert Christenson; Silvia Weiser; Garnet Bendig; Peter Dilba

doi:10.1093/eurheartj/ehy514

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

Jasper Boeddinghaus, Thomas Nestelberger, Raphael Twerenbold, Johannes Tobias Neumann, Bertil Lindahl, Evangelos Giannitsis, Nils Arne Sorensen, Patrick Badertscher, Janina E. Jann, Desiree Wussler, Christian Puelacher, Maria Rubini Gimenez, Karin Wildi, Ivo Strebel, Jeanne Du Fay de Lavallaz, Farah Selman, Zaid Sabti, Nikola Kozhuharov, Eliska Potlukova, Katharina RentschOscar Miro, F. Javier Martin-Sanchez, Beata Morawiec, Jiri Parenica, Jens Lohrmann, Wanda Kloos, Andreas Buser, Nicolas Geigy, Dagmar I. Keller, Stefan Osswald, Tobias Reichlin, Dirk Westermann, Stefan Blankenberg, Christian Mueller, Samyut Shrestha, Dayana Flores, Michael Freese, Claudia Stelzig, Caroline Kulangara, Kathrin Meissner, Nicolas Schaerli, Deborah Mueller, Lorraine Sazgary, Stella Marbot, Beatriz Lopez, Sofia Calderon, Esther Rodriguez Adrada, Damian Kawecki, Ewa Nowalany-Kozielska, Eva Ganovska, Arnold Von Eckardstein, Isabel Campodarve, Michael Christ, Jorge Ordonez-Llanos, Christopher R. De Filippi, James McCord, Richard Body, Mauro Panteghini, Thomas Jernberg, Mario Plebani, Franck Verschuren, John K. French, Robert Christenson, Silvia Weiser, Garnet Bendig, Peter Dilba

Western Sydney University

Research output: Contribution to journal › Article › peer-review

99 Citations (Scopus)

Abstract

Aims We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1halgorithms 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 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 [<55 years (young), ≥55 to <70 years (middle-age), ≥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 97.5- 99.8) 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 < 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 < 0.01), reduced overall efficacy for hs-cTnT (P < 0.01), while maintaining efficacy for hs-cTnI. 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-cTnI.

Original language	English
Pages (from-to)	3780-3794
Number of pages	15
Journal	European Heart Journal
Volume	39
Issue number	42
DOIs	https://doi.org/10.1093/eurheartj/ehy514
Publication status	Published - 2018

Access to Document

10.1093/eurheartj/ehy514

Cite this

Boeddinghaus, J., Nestelberger, T., Twerenbold, R., Neumann, J. T., Lindahl, B., Giannitsis, E., Sorensen, N. A., Badertscher, P., Jann, J. E., Wussler, D., Puelacher, C., Gimenez, M. R., Wildi, K., Strebel, I., Du Fay de Lavallaz, J., Selman, F., Sabti, Z., Kozhuharov, N., Potlukova, E., ... Dilba, P. (2018). Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction. European Heart Journal, 39(42), 3780-3794. https://doi.org/10.1093/eurheartj/ehy514

@article{91f86a621f544474b5144ee52547a7d3,

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

abstract = "Aims We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1halgorithms 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 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 [<55 years (young), ≥55 to <70 years (middle-age), ≥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 97.5- 99.8) 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 < 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 < 0.01), reduced overall efficacy for hs-cTnT (P < 0.01), while maintaining efficacy for hs-cTnI. 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-cTnI.",

author = "Jasper Boeddinghaus and Thomas Nestelberger and Raphael Twerenbold and Neumann, {Johannes Tobias} and Bertil Lindahl and Evangelos Giannitsis and Sorensen, {Nils Arne} and Patrick Badertscher and Jann, {Janina E.} and Desiree Wussler and Christian Puelacher and Gimenez, {Maria Rubini} and Karin Wildi and Ivo Strebel and {Du Fay de Lavallaz}, Jeanne and Farah Selman and Zaid Sabti and Nikola Kozhuharov and Eliska Potlukova and Katharina Rentsch and Oscar Miro and Martin-Sanchez, {F. Javier} and Beata Morawiec and Jiri Parenica and Jens Lohrmann and Wanda Kloos and Andreas Buser and Nicolas Geigy and Keller, {Dagmar I.} and Stefan Osswald and Tobias Reichlin and Dirk Westermann and Stefan Blankenberg and Christian Mueller and Samyut Shrestha and Dayana Flores and Michael Freese and Claudia Stelzig and Caroline Kulangara and Kathrin Meissner and Nicolas Schaerli and Deborah Mueller and Lorraine Sazgary and Stella Marbot and Beatriz Lopez and Sofia Calderon and Adrada, {Esther Rodriguez} and Damian Kawecki and Ewa Nowalany-Kozielska and Eva Ganovska and {Von Eckardstein}, Arnold and Isabel Campodarve and Michael Christ and Jorge Ordonez-Llanos and {De Filippi}, {Christopher R.} and James McCord and Richard Body and Mauro Panteghini and Thomas Jernberg and Mario Plebani and Franck Verschuren and French, {John K.} and Robert Christenson and Silvia Weiser and Garnet Bendig and Peter Dilba",

year = "2018",

doi = "10.1093/eurheartj/ehy514",

language = "English",

volume = "39",

pages = "3780--3794",

journal = "European Heart Journal",

issn = "1522-9645",

publisher = "Oxford University Press",

number = "42",

}

Boeddinghaus, J, Nestelberger, T, Twerenbold, R, Neumann, JT, Lindahl, B, Giannitsis, E, Sorensen, NA, Badertscher, P, Jann, JE, Wussler, D, Puelacher, C, Gimenez, MR, Wildi, K, Strebel, I, Du Fay de Lavallaz, J, Selman, F, Sabti, Z, Kozhuharov, N, Potlukova, E, Rentsch, K, Miro, O, Martin-Sanchez, FJ, Morawiec, B, Parenica, J, Lohrmann, J, Kloos, W, Buser, A, Geigy, N, Keller, DI, Osswald, S, Reichlin, T, Westermann, D, Blankenberg, S, Mueller, C, Shrestha, S, Flores, D, Freese, M, Stelzig, C, Kulangara, C, Meissner, K, Schaerli, N, Mueller, D, Sazgary, L, Marbot, S, Lopez, B, Calderon, S, Adrada, ER, Kawecki, D, Nowalany-Kozielska, E, Ganovska, E, Von Eckardstein, A, Campodarve, I, Christ, M, Ordonez-Llanos, J, De Filippi, CR, McCord, J, Body, R, Panteghini, M, Jernberg, T, Plebani, M, Verschuren, F, French, JK, Christenson, R, Weiser, S, Bendig, G & Dilba, P 2018, 'Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction', European Heart Journal, vol. 39, no. 42, pp. 3780-3794. https://doi.org/10.1093/eurheartj/ehy514

TY - JOUR

T1 - Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction

AU - Boeddinghaus, Jasper

AU - Nestelberger, Thomas

AU - Twerenbold, Raphael

AU - Neumann, Johannes Tobias

AU - Lindahl, Bertil

AU - Giannitsis, Evangelos

AU - Sorensen, Nils Arne

AU - Badertscher, Patrick

AU - Jann, Janina E.

AU - Wussler, Desiree

AU - Puelacher, Christian

AU - Gimenez, Maria Rubini

AU - Wildi, Karin

AU - Strebel, Ivo

AU - Du Fay de Lavallaz, Jeanne

AU - Selman, Farah

AU - Sabti, Zaid

AU - Kozhuharov, Nikola

AU - Potlukova, Eliska

AU - Rentsch, Katharina

AU - Miro, Oscar

AU - Martin-Sanchez, F. Javier

AU - Morawiec, Beata

AU - Parenica, Jiri

AU - Lohrmann, Jens

AU - Kloos, Wanda

AU - Buser, Andreas

AU - Geigy, Nicolas

AU - Keller, Dagmar I.

AU - Osswald, Stefan

AU - Reichlin, Tobias

AU - Westermann, Dirk

AU - Blankenberg, Stefan

AU - Mueller, Christian

AU - Shrestha, Samyut

AU - Flores, Dayana

AU - Freese, Michael

AU - Stelzig, Claudia

AU - Kulangara, Caroline

AU - Meissner, Kathrin

AU - Schaerli, Nicolas

AU - Mueller, Deborah

AU - Sazgary, Lorraine

AU - Marbot, Stella

AU - Lopez, Beatriz

AU - Calderon, Sofia

AU - Adrada, Esther Rodriguez

AU - Kawecki, Damian

AU - Nowalany-Kozielska, Ewa

AU - Ganovska, Eva

AU - Von Eckardstein, Arnold

AU - Campodarve, Isabel

AU - Christ, Michael

AU - Ordonez-Llanos, Jorge

AU - De Filippi, Christopher R.

AU - McCord, James

AU - Body, Richard

AU - Panteghini, Mauro

AU - Jernberg, Thomas

AU - Plebani, Mario

AU - Verschuren, Franck

AU - French, John K.

AU - Christenson, Robert

AU - Weiser, Silvia

AU - Bendig, Garnet

AU - Dilba, Peter

PY - 2018

Y1 - 2018

N2 - Aims We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1halgorithms 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 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 [<55 years (young), ≥55 to <70 years (middle-age), ≥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 97.5- 99.8) 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 < 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 < 0.01), reduced overall efficacy for hs-cTnT (P < 0.01), while maintaining efficacy for hs-cTnI. 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-cTnI.

AB - Aims We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1halgorithms 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 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 [<55 years (young), ≥55 to <70 years (middle-age), ≥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 97.5- 99.8) 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 < 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 < 0.01), reduced overall efficacy for hs-cTnT (P < 0.01), while maintaining efficacy for hs-cTnI. 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-cTnI.

UR - https://hdl.handle.net/1959.7/uws:63602

U2 - 10.1093/eurheartj/ehy514

DO - 10.1093/eurheartj/ehy514

M3 - Article

SN - 1522-9645

SN - 0195-668X

VL - 39

SP - 3780

EP - 3794

JO - European Heart Journal

JF - European Heart Journal

IS - 42

ER -

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

Abstract

Access to Document

Other files and links

Fingerprint

Cite this