PMID- 27288278
OWN - NLM
STAT- MEDLINE
DCOM- 20170717
LR  - 20191210
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 102
IP  - 16
DP  - 2016 Aug 15
TI  - Validation of NICE diagnostic guidance for rule out of myocardial infarction 
      using high-sensitivity troponin tests.
PG  - 1279-86
LID - 10.1136/heartjnl-2016-309270 [doi]
AB  - OBJECTIVE: To validate the National Institute for Health and Care Excellence 
      (NICE) recommended algorithms for high-sensitivity troponin (hsTn) assays in 
      adults presenting with chest pain. METHODS: International post hoc analysis of 
      three prospective, observational studies from tertiary hospital emergency 
      departments. The primary endpoint was cardiac death or acute myocardial 
      infarction (AMI) within 24 hours of presentation, and the secondary endpoint was 
      major adverse cardiac events (MACE) at 30 days. RESULTS: 15% of patients were 
      diagnosed with non-ST elevation myocardial infarction (MI) on admission. The 
      hsTnI algorithm classified 2506/3128 (80.1%) of patients as 'ruled out' with 50 
      (2.0%) missed MI. 943/3128 (30.1%) of patients had a troponin I level below the 
      limit of detection on admission with 2 (0.2%) missed MI. For the hsTnT algorithm, 
      1794/3374 (53.1%) of patients were 'ruled out' with 7 (0.4%) missed MI. 490/3374 
      (14.5%) of patients had a troponin T below the limit of blank on admission with 
      no MI. MACE at 30 days occurred in 10.7% and 8.5% of patients 'ruled out' defined 
      by the hsTnI and hsTnT algorithms, respectively. CONCLUSIONS: The NICE algorithms 
      could identify patients with low probability of AMI within 2 hours; however, 
      neither strategy performed as predicted by the NICE diagnostic guidance model. 
      Additionally, the rate of MACE at 30 days was sufficiently high that the 
      algorithms should only be used as one component of a more extensive model of risk 
      stratification. TRIAL REGISTRATION NUMBER: ACTRN12611001069943, NCT00470587; 
      post-results.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not 
      already granted under a licence) please go to 
      http://www.bmj.com/company/products-services/rights-and-licensing/
FAU - Parsonage, W A
AU  - Parsonage WA
AD  - Royal Brisbane & Women's Hospital, Herston, Australia.
FAU - Mueller, C
AU  - Mueller C
AD  - Cardiovascular Research Institute, University Hospital, Basel, Switzerland.
FAU - Greenslade, J H
AU  - Greenslade JH
AD  - Royal Brisbane & Women's Hospital, Herston, Australia.
FAU - Wildi, K
AU  - Wildi K
AD  - Cardiovascular Research Institute, University Hospital, Basel, Switzerland.
FAU - Pickering, J
AU  - Pickering J
AD  - Christchurch Hospital, Christchurch, New Zealand.
FAU - Than, M
AU  - Than M
AD  - Christchurch Hospital, Christchurch, New Zealand.
FAU - Aldous, S
AU  - Aldous S
AD  - Christchurch Hospital, Christchurch, New Zealand.
FAU - Boeddinghaus, J
AU  - Boeddinghaus J
AD  - Cardiovascular Research Institute, University Hospital, Basel, Switzerland.
FAU - Hammett, C J
AU  - Hammett CJ
AD  - Royal Brisbane & Women's Hospital, Herston, Australia.
FAU - Hawkins, T
AU  - Hawkins T
AD  - Royal Brisbane & Women's Hospital, Herston, Australia.
FAU - Nestelberger, T
AU  - Nestelberger T
AD  - Cardiovascular Research Institute, University Hospital, Basel, Switzerland.
FAU - Reichlin, T
AU  - Reichlin T
AD  - Cardiovascular Research Institute, University Hospital, Basel, Switzerland.
FAU - Reidt, S
AU  - Reidt S
AD  - Cardiovascular Research Institute, University Hospital, Basel, Switzerland.
FAU - Rubin Gimenez, M
AU  - Rubin Gimenez M
AD  - Cardiovascular Research Institute, University Hospital, Basel, Switzerland.
FAU - Tate, J R
AU  - Tate JR
AD  - Royal Brisbane & Women's Hospital, Herston, Australia.
FAU - Twerenbold, R
AU  - Twerenbold R
AD  - Cardiovascular Research Institute, University Hospital, Basel, Switzerland.
FAU - Ungerer, J P
AU  - Ungerer JP
AD  - Royal Brisbane & Women's Hospital, Herston, Australia.
FAU - Cullen, L
AU  - Cullen L
AD  - Royal Brisbane & Women's Hospital, Herston, Australia.
LA  - eng
SI  - ClinicalTrials.gov/NCT00470587
SI  - ANZCTR/ACTRN12611001069943
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
PT  - Validation Study
DEP - 20160610
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Biomarkers)
RN  - 0 (Troponin I)
RN  - 0 (Troponin T)
SB  - IM
CIN - Ann Intern Med. 2016 Oct 18;165(8):JC47. PMID: 27750307
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Algorithms
MH  - Angina Pectoris/diagnosis/etiology
MH  - Biomarkers/*blood
MH  - Cardiology Service, Hospital/standards
MH  - *Decision Support Techniques
MH  - Emergency Service, Hospital/standards
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/blood/complications/*diagnosis
MH  - New Zealand
MH  - Practice Guidelines as Topic/*standards
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Prospective Studies
MH  - Queensland
MH  - Reproducibility of Results
MH  - Switzerland
MH  - Tertiary Care Centers
MH  - Time Factors
MH  - Troponin I/*blood
MH  - Troponin T/*blood
MH  - Up-Regulation
MH  - Young Adult
EDAT- 2016/06/12 06:00
MHDA- 2017/07/18 06:00
CRDT- 2016/06/12 06:00
PHST- 2016/01/09 00:00 [received]
PHST- 2016/05/16 00:00 [accepted]
PHST- 2016/06/12 06:00 [entrez]
PHST- 2016/06/12 06:00 [pubmed]
PHST- 2017/07/18 06:00 [medline]
AID - heartjnl-2016-309270 [pii]
AID - 10.1136/heartjnl-2016-309270 [doi]
PST - ppublish
SO  - Heart. 2016 Aug 15;102(16):1279-86. doi: 10.1136/heartjnl-2016-309270. Epub 2016 
      Jun 10.