Abstract:
OBJECTIVES:The study objective was to validate a new high-sensitivity troponin I (hs-TnI) assay in a clinical protocol for assessing patients who present to the emergency department with chest pain. BACKGROUND:Protocols using sensitive troponin assays can accelerate the rule out of acute myocardial infarction in patients with low-risk (suspected) acute coronary syndrome (ACS). METHODS:This study evaluated 2 prospective cohorts of patients in the emergency department with ACS in an accelerated diagnostic pathway integrating 0- and 2-h hs-TnI results, Thrombolysis In Myocardial Infarction (TIMI) risk scores, and electrocardiography. Strategies to identify low-risk patients incorporated TIMI risk scores= 0 or ≤ 1. The primary endpoint was a major adverse cardiac event (MACE) within 30 days. RESULTS:In the primary cohort, 1,635 patients were recruited and had 30-day follow-up. A total of 247 patients (15.1%) had a MACE. The finding of no ischemic electrocardiogram and hs-TnI ≤ 26.2 ng/l with the TIMI = 0 and TIMI ≤ 1 pathways, respectively, classified 19.6% (n = 320) and 41.5% (n = 678) of these patients as low risk; 0% (n = 0) and 0.8% (n = 2) had a MACE, respectively. In the secondary cohort, 909 patients were recruited. A total of 156 patients (17.2%) had a MACE. The TIMI = 0 and TIMI ≤ 1 pathways classified 25.3% (n = 230) and 38.6% (n = 351), respectively, of these patients as low risk; 0% (n = 0) and 0.8% (n = 1) had a MACE, respectively. Sensitivity, specificity, and negative predictive value for TIMI = 0 in the primary cohort were 100% (95% confidence interval [CI]: 98.5% to 100%), 23.1% (95% CI: 20.9% to 25.3%), and 100% (95% CI: 98.8% to 100%), respectively. Sensitivity, specificity, and negative predictive value for TIMI ≤ 1 in the primary cohort were 99.2 (95% CI: 97.1 to 99.8), 48.7 (95% CI: 46.1 to 51.3), and 99.7 (95% CI: 98.9 to 99.9), respectively. Sensitivity, specificity, and negative value for TIMI ≤ 1 in the secondary cohort were 99.4% (95% CI: 96.5 to 100), 46.5% (95% CI: 42.9 to 50.1), and 99.7% (95% CI: 98.4 to 100), respectively. CONCLUSIONS:An early-discharge strategy using an hs-TnI assay and TIMI score ≤ 1 had similar safety as previously reported, with the potential to decrease the observation periods and admissions for approximately 40% of patients with suspected ACS. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study, NCT00470587; A 2 hr Accelerated Diagnostic Protocol to Assess patients with chest Pain symptoms using contemporary Troponins as the only biomarker [ADAPT]: a prospective observational validation study, ACTRN12611001069943).
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Cullen L,Mueller C,Parsonage WA,Wildi K,Greenslade JH,Twerenbold R,Aldous S,Meller B,Tate JR,Reichlin T,Hammett CJ,Zellweger C,Ungerer JPJ,Rubini Gimenez M,Troughton R,Murray K,Brown AFT,Mueller M,George P,Mosimanndoi
10.1016/j.jacc.2013.02.078subject
Has Abstractpub_date
2013-10-01 00:00:00pages
1242-1249issue
14eissn
0735-1097issn
1558-3597pii
S0735-1097(13)01410-1journal_volume
62pub_type
杂志文章,多中心研究,随机对照试验abstract:OBJECTIVES:We tested the hypothesis that risk of ischemic heart disease (IHD) differs as a function of apolipoprotein E (APOE) genotype in women and men. BACKGROUND:Apolipoprotein E genotype influences lipids and lipoproteins and, therefore, possibly the risk of IHD. METHODS:We genotyped 9,241 white women and men fro...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(00)00520-9
更新日期:2000-04-01 00:00:00
abstract:OBJECTIVES:This study was designed to evaluate possible interactions between digital mobile telephones and implanted pacemakers. BACKGROUND:Electromagnetic fields may interfere with normal pacemaker function. Development of bipolar sensing leads and modern noise filtering techniques have lessened this problem. However...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(96)00031-9
更新日期:1996-05-01 00:00:00
abstract:OBJECTIVES:This study examined the influence of left ventricular hypertrophy on the accuracy of exercise electrocardiography and echocardiography for detection of coronary artery disease. BACKGROUND:Electrocardiographic repolarization abnormalities caused by left ventricular hypertrophy compromise the diagnostic accur...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章
doi:10.1016/0735-1097(96)81472-0
更新日期:1995-11-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to investigate the significance of non-type 1 anterior early repolarization (NT1-AER) combined with inferolateral early repolarization syndrome (ERS). BACKGROUND:Inferolateral ERS might be a heterogeneous entity, although it excludes type 1 Brugada syndrome (BS). METHODS:Of 84 pat...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2013.05.081
更新日期:2013-10-22 00:00:00
abstract:OBJECTIVES:The purpose of this study was to evaluate the feasibility of re-expansion of balloon expandable intravascular stents and to examine the gross and histologic effects of re-expansion on vascular integrity. BACKGROUND:Intravascular stents have been used successfully as an adjunct to balloon dilation of congeni...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(93)90791-x
更新日期:1993-12-01 00:00:00
abstract::Forty-two defibrillating lead systems for the automatic implantable defibrillator were implanted and tested in 41 patients. Two basic lead configurations were used: 1) spring-patch, consisting of a transvenous superior vena cava spring electrode as the anode and an apical or left lateral ventricular patch electrode (e...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(85)80219-9
更新日期:1985-12-01 00:00:00
abstract:OBJECTIVES:Our aim was to measure the cardiac phosphocreatine to adenosine triphosphate ratio (PCr/ATP) noninvasively in patients and carriers of Xp21 muscular dystrophy and to correlate the results with left ventricular (LV) function as measured by echocardiography. BACKGROUND:Duchenne and Becker muscular dystrophy (...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(00)00960-8
更新日期:2000-11-15 00:00:00
abstract::Four electrocardiographic scoring systems for the assessment of left ventricular function or presence of myocardial infarction were evaluated in 231 patients with coronary artery disease. Electrocardiographic scores were compared with radionuclide ejection fraction and thallium perfusion studies. The correlation betwe...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(83)80052-7
更新日期:1983-06-01 00:00:00
abstract:OBJECTIVES:We sought to determine the effects of cardiac resynchronization therapy (CRT) in New York Heart Association (NYHA) functional class II heart failure (HF) and NYHA functional class I (American College of Cardiology/American Heart Association stage C) patients with previous HF symptoms. BACKGROUND:Cardiac res...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jacc.2008.08.027
更新日期:2008-12-02 00:00:00
abstract:BACKGROUND:Circulating high-density lipoprotein particle (HDL-P) subfractions impact atherogenesis, inflammation, and endothelial function, all of which are implicated in the pathobiology of heart failure (HF). OBJECTIVES:The authors sought to identify key differences in plasma HDL-P subfractions between patients with...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2018.10.059
更新日期:2019-01-22 00:00:00
abstract:OBJECTIVES:The aim of our study was to assess the value of transesophageal echocardiography (TEE) in predicting embolic events (EEs) in a large group of patients with definite endocarditis according to the Duke criteria, including silent embolism. BACKGROUND:The value of echocardiography in predicting embolism in pati...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(00)01206-7
更新日期:2001-03-15 00:00:00
abstract:OBJECTIVES:We sought to demonstrate the prevalence, incidence and prognostic value of the Brugada-type electrocardiogram (ECG) in a general population. BACKGROUND:The Brugada syndrome is characterized by evidence of right bundle branch block and ST segment elevation in the right precordial leads, as well as sudden dea...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(01)01421-8
更新日期:2001-09-01 00:00:00
abstract:OBJECTIVES:This study was performed to assess whether angiography six months after coronary balloon angioplasty or stent implantation has an influence on clinical management and one-year outcome. BACKGROUND:The Benestent II study randomized 827 patients to balloon angioplasty or stent implantation. A subrandomization ...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0735-1097(99)00380-0
更新日期:1999-11-01 00:00:00
abstract::Nicardipine, a new dihydropyridine calcium channel blocker, has been investigated for the treatment of coronary artery disease and heart failure. To assess the inotropic effect of nicardipine in humans independent of its vasodilator effect, equihypotensive doses of intravenous nitroprusside (mean infusion rate 65 +/- ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(89)90437-3
更新日期:1989-11-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to determine the efficacy and safety of enoxaparin (ENOX) versus unfractionated heparin (UFH) in patients with ST-segment elevation myocardial infarction (STEMI) receiving fibrinolytic therapy with and without clopidogrel. BACKGROUND:The efficacy and safety of ENOX and clopidog...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jacc.2007.01.092
更新日期:2007-06-12 00:00:00
abstract::To clarify the role of serotonin in eliciting myocardial ischemia, the effects of serotonin on coronary vasculature and cardiac performance were examined in anesthetized open chest dogs. Without coronary stenosis, intracoronary infusion of serotonin (0.001 to 1.0 micrograms/kg per min) for 40 s caused dose-dependent i...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(89)90201-5
更新日期:1989-08-01 00:00:00
abstract:UNLABELLED:The relationship between renal insufficiency and amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels remains unclear. We examined this relationship in the context of patients who presented to the emergency department of an urban tertiary care medical center with dyspnea. Even in the presence of r...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.08.051
更新日期:2006-01-03 00:00:00
abstract:OBJECTIVES:We investigated the prevalence of lamin A/C (LMNA) gene defects in familial and sporadic dilated cardiomyopathies (DCM) associated with atrioventricular block (AVB) or increased serum creatine-phosphokinase (sCPK), and the corresponding changes in myocardial and protein expression. BACKGROUND:It has been re...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(02)01724-2
更新日期:2002-03-20 00:00:00
abstract:OBJECTIVES:The goal of this study was to evaluate the utility of a rapid "bedside" technique for measurement of B-type natriuretic peptide (BNP) in the diagnosis of congestive heart failure (CHF) in an urgent-care setting. BACKGROUND:B-type natriuretic peptide is a protein secreted from the cardiac ventricles in respo...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(00)01156-6
更新日期:2001-02-01 00:00:00
abstract:OBJECTIVES:We sought to evaluate the impact of dobutamine stress echocardiography (DSE) in patients with known rheumatic mitral stenosis (MS) in order to assess its safety, feasibility, and prognostic correlation to well-known clinical outcomes. BACKGROUND:Noninvasive prognostic assessment of MS still represents an un...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2003.09.037
更新日期:2004-02-04 00:00:00
abstract:OBJECTIVES:We examined the risk of coronary heart disease associated with homozygosity for the C677T mutation in the methylenetetrahydrofolate reductase gene. BACKGROUND:The mutation increases plasma homocysteine levels by impairing its remethylation. Increased plasma homocysteine is an independent risk factor for car...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(98)00244-7
更新日期:1998-08-01 00:00:00
abstract:OBJECTIVES:This study determined the effects of inhaled nitric oxide (NO) on load-independent indexes of normal human left ventricular (LV) function. BACKGROUND:Inhaled NO is a potent and selective pulmonary vasodilator. However, when it is used in patients with congestive heart failure, the decrease in pulmonary vasc...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(97)00143-5
更新日期:1997-07-01 00:00:00
abstract:OBJECTIVES:This study was performed to describe the initial experience and follow-up of ultrasound-guided compression of pseudoaneurysms in patients receiving systemic anticoagulant or antiplatelet therapy, or both, after recent cardiac catheterization or percutaneous transluminal coronary angioplasty. BACKGROUND:Femo...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(92)90015-f
更新日期:1992-09-01 00:00:00
abstract::Anthracycline compounds are major culprits in chemotherapy-induced cardiotoxicity, which is the chief limiting factor in delivering optimal chemotherapy to cancer patients. Although extensive efforts have been devoted to identifying strategies to prevent anthracycline-induced cardiotoxicity, there is little consensus ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2014.06.1167
更新日期:2014-09-02 00:00:00
abstract::Recently, there has been a resurgence of interest in the use of contrast-enhanced echocardiography as a means of noninvasively assessing myocardial perfusion. However, if injections of echocardiographic contrast agents are to be used for this purpose it is essential that they are not intrinsically toxic to the heart. ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(87)80250-4
更新日期:1987-04-01 00:00:00
abstract:OBJECTIVES:This study was directed at developing spatial 62-lead electrocardiogram (ECG) criteria for classification of counterclockwise (CCW) and clockwise (CW) typical atrial flutter (Fl) in patients with and without structural heart disease. BACKGROUND:Electrocardiographic classification of CCW and CW typical atria...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(00)00549-0
更新日期:2000-04-01 00:00:00
abstract:OBJECTIVES:This study was designed to determine the prevalence of peripheral arterial disease (PAD) in candidates for coronary artery bypass grafting (CABG) and to assess the predictive value of different types of subclinical PAD (peripheral occlusive disease and medial arterial calcification [incompressible ankle arte...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.05.066
更新日期:2005-09-06 00:00:00
abstract:OBJECTIVES:The purpose of this study was to compare the mechanisms, predictors and outcome of patients with failed direct coronary angioplasty of the infarct-related artery with those in patients with successful direct angioplasty. BACKGROUND:Direct coronary angioplasty of the infarct-related artery, without anteceden...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(93)90178-4
更新日期:1993-09-01 00:00:00
abstract::The appropriateness and timing of mitral valve surgery in patients with advanced heart failure and severe mitral regurgitation remains controversial. Recent surgical results provide evidence for beneficial effects on left ventricular remodeling and functional capacity. Given the absence of randomized trials comparing ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2009.08.059
更新日期:2010-01-26 00:00:00
abstract:OBJECTIVES:We sought to establish the diagnostic accuracy of transesophageal echocardiography (TEE) during cardiopulmonary resuscitation. BACKGROUND:Because of its bedside diagnostic capabilities, excellent cardiac images and lack of interference with resuscitation efforts, TEE is ideally suited to determine the cause...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章
doi:10.1016/s0735-1097(97)00218-0
更新日期:1997-09-01 00:00:00