ALARRM: A laboratory approach for rapid risk-assessment for myocardial infarction.

IF 2.9 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Clinica Chimica Acta Pub Date : 2025-09-27 DOI:10.1016/j.cca.2025.120630

Peter A Kavsak, Sameer Sharif, Craig Ainsworth, Jinhui Ma, Shawn E Mondoux, Dennis T Ko, Andrew Worster

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引用次数: 0

Abstract

Background: Current pathways using high-sensitivity cardiac troponin (hs-cTn) to rule in and rule out myocardial infarction (MI) are assay specific. This requires clinicians and laboratories to use the correct assay-specific cutoffs, deltas, and time between measurements for optimal decision making. To overcome these challenges, we developed a new common laboratory pathway (i.e., ALARRM: a laboratory approach for rapid risk-assessment for MI) to aid in early risk stratification for MI in the emergency department (ED) using the combined validated clinical chemistry score (CCS) and common change criteria (3C) algorithm. The objective of our study was to assess the diagnostic performance (sensitivity and specificity) and effectiveness (combination of rule out/low risk and rule in/high risk) of ALARRM.

Methods: The study cohort (n = 855) consisted of patients presenting to the ED with acute coronary syndrome symptoms and had two blood samples collected three hours apart for measurement of Abbott hs-cTnI, Ortho hs-cTnI, Roche hs-cTnT, glucose, and creatinine (for the estimated glomerular filtration rate (eGFR) calculation). We also assessed the European society of cardiology (ESC) single sample assay-specific cutoffs with both ALARRM and ESC criteria being assessed for index MI in the cohort.

Results: The sensitivity for MI using ALARRM was 100 % for all three assays, however this was not the case for the ESC single cutoffs where the Ortho hs-cTnI assay missed 4 MIs. The specificities in patients with serial measurements with ALARRM were > 90 %, with the overall effectiveness for ALARRM being 61 % (95 %CI: 58 to 64) for Roche, 80 % (95 %CI: 77 to 82) for Abbott, and 89 % (95 %CI: 86 to 91) for Ortho.

Conclusion: The ALARRM pathway represents a highly efficacious and common approach using hs-cTn for early risk stratification for MI.

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警报：一种快速评估心肌梗死风险的实验室方法。

背景：目前使用高灵敏度心肌肌钙蛋白（hs-cTn）诊断和排除心肌梗死（MI）的途径是检测特异性的。这要求临床医生和实验室使用正确的测定特定的截止点、delta和测量之间的时间来做出最佳决策。为了克服这些挑战，我们开发了一种新的通用实验室途径（即ALARRM：一种用于心肌梗死快速风险评估的实验室方法），以帮助急诊部（ED）使用联合验证的临床化学评分（CCS）和共同变化标准（3C）算法对心肌梗死进行早期风险分层。我们研究的目的是评估ALARRM的诊断性能（敏感性和特异性）和有效性（排除/低风险和规则/高风险的组合）。方法：研究队列（n = 855）由出现急性冠状动脉综合征症状的ED患者组成，每隔3小时采集两次血液样本，测量雅培hs-cTnI、Ortho hs-cTnI、罗氏hs-cTnT、葡萄糖和肌酐（用于估算肾小球滤过率（eGFR））。我们还评估了欧洲心脏病学会（ESC）单样本分析特异性截止值，同时评估了队列中心肌梗死指数的alarmm和ESC标准。结果：使用alarmm检测MI的灵敏度为100% %，所有三种检测方法都是如此，然而ESC单截止值并非如此，其中Ortho hs-cTnI检测错过了4个MIs。连续测量患者的特异性与ALARRM > 90 %,与整体有效性ALARRM是61 %(95 % CI: 58 - 64)为罗氏80 %(95 %置信区间:77至82年)雅培,和89年 %(95 %置信区间:86 - 91)为正的。结论：使用hs-cTn进行心肌梗死早期风险分层，alarmm途径是一种高效且常用的方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinica Chimica Acta 医学-医学实验技术

CiteScore

10.10

自引率

2.00%

发文量

1268

审稿时长

23 days

期刊介绍： The Official Journal of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Clinica Chimica Acta is a high-quality journal which publishes original Research Communications in the field of clinical chemistry and laboratory medicine, defined as the diagnostic application of chemistry, biochemistry, immunochemistry, biochemical aspects of hematology, toxicology, and molecular biology to the study of human disease in body fluids and cells. The objective of the journal is to publish novel information leading to a better understanding of biological mechanisms of human diseases, their prevention, diagnosis, and patient management. Reports of an applied clinical character are also welcome. Papers concerned with normal metabolic processes or with constituents of normal cells or body fluids, such as reports of experimental or clinical studies in animals, are only considered when they are clearly and directly relevant to human disease. Evaluation of commercial products have a low priority for publication, unless they are novel or represent a technological breakthrough. Studies dealing with effects of drugs and natural products and studies dealing with the redox status in various diseases are not within the journal''s scope. Development and evaluation of novel analytical methodologies where applicable to diagnostic clinical chemistry and laboratory medicine, including point-of-care testing, and topics on laboratory management and informatics will also be considered. Studies focused on emerging diagnostic technologies and (big) data analysis procedures including digitalization, mobile Health, and artificial Intelligence applied to Laboratory Medicine are also of interest.