Study objective

The aim of this study was to investigate whether myocardial infarction can be safely ruled in or out after 30 minutes as an alternative to 1 hour.

Methods

This was a prospective, single-center clinical study enrolling patients admitted to the emergency department. Patients with chest pain suggestive of myocardial infarction were eligible for inclusion. There was no walk-in to the emergency department, and patients with highly elevated out-of-hospital troponin were transferred directly to an invasive heart center. High-sensitivity troponin I was measured at admission (0 hour), 30 minutes, 1 hour, and 3 hours. Diagnostic performance was assessed using the sensitivity and negative predictive value (primary endpoints) as measures of ability to rule out myocardial infarction. Specificity and positive predictive value of myocardial infarction were used as measures for the ability to rule in myocardial infarction (secondary endpoints).

Results

In total, 1,003 patients qualified for analysis. Median age was 64 (interquartile range 52 to 74) years, and 42% were women. Myocardial infarction was confirmed in 9% of patients. In the validation cohort (n=503), the 0-h/30-min algorithm assigned 242 (48%) patients to rule out, 54 (11%) to rule in, and 207 (41%) to the observational zone. This resulted in a sensitivity of 100% (92.0% to 100%), negative predictive value of 100% (95% confidence interval 98.5% to 100%), specificity of 96.7% (94.7% to 98.2%), and positive predictive value of 72.2% (58.4% to 83.5%). In comparison, the 0-h/1-h algorithm performed with a sensitivity of 100% (92.0% to 100%), negative predictive value of 100% (98.5% to 100%), specificity of 97.2% (95.2% to 98.5%), and positive predictive value of 75.5% (61.7% to 86.2%).

Conclusion

The accelerated 0-h/30-min algorithm allowed for safe rule-out of myocardial infarction 30 minutes after admission. The rule-in ability of the 0-h/30-min algorithm was comparable to that of the 0-h/1h algorithm.

中文翻译：

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30 分钟后快速排除心肌梗塞替代 1 小时：RACING-MI 队列研究

学习目标

本研究的目的是调查是否可以在 30 分钟后安全排除或排除心肌梗塞，而不是 1 小时。

方法

这是一项前瞻性、单中心临床研究，招募了急诊科的患者。胸痛提示心肌梗死的患者符合入选条件。急诊室没有步入，院外肌钙蛋白升高的患者被直接转移到侵入性心脏中心。在入院（0 小时）、30 分钟、1 小时和 3 小时时测量高敏肌钙蛋白 I。使用敏感性和阴性预测值（主要终点）评估诊断性能作为排除心肌梗塞的能力。心肌梗塞的特异性和阳性预测值被用作衡量心肌梗塞（次要终点）的能力。

结果

总共有 1,003 名患者符合分析条件。中位年龄为 64 岁（四分位距为 52 至 74）岁，42% 为女性。9% 的患者证实有心肌梗塞。在验证队列 (n = 503) 中，0 小时/30 分钟算法将 242 名 (48%) 患者排除在外，将 54 名 (11%) 患者排除在外，将 207 名 (41%) 患者分配到观察区。这导致灵敏度为 100%（92.0% 至 100%）、阴性预测值为 100%（95% 置信区间为 98.5% 至 100%）、特异性为 96.7%（94.7% 至 98.2%）和阳性预测值72.2%（58.4% 至 83.5%）。相比之下，0-h/1-h 算法的灵敏度为 100%（92.0% 至 100%），阴性预测值为 100%（98.5% 至 100%），特异性为 97.2%（95.2% 至 98.5） %），阳性预测值为 75.5%（61.7% 至 86.2%）。

结论

加速 0 小时/30 分钟算法允许在入院后 30 分钟安全排除心肌梗塞。0-h/30-min 算法的规则能力与 0-h/1h 算法相当。