Project

Back to overview

Advantageous Predictors of Acute Coronary Syndromes Evaluation (APACE) Study: Validation

English title Advantageous Predictors of Acute Coronary Syndromes Evaluation (APACE) Study: Validation
Applicant Mueller Christian
Number 159495
Funding scheme Project funding (Div. I-III)
Research institution Klinik für Kardiologie Bereich Medizin Universitätsspital Basel
Institution of higher education University of Basel - BS
Main discipline Internal Medicine
Start/End 01.04.2015 - 31.03.2018
Approved amount 474'000.00
Show all

All Disciplines (2)

Discipline
Internal Medicine
Clinical Cardiovascular Research

Keywords (4)

cardiac troponin; diagnosis; chest pain; acute myocardial infarction

Lay Summary (German)

Lead
Advantageous Predictors of Acute Coronary Syndromes Evaluation Study (APACE): Validation
Lay summary

Hintergrund: Der Herzinfarkt ist eine Hauptursache für Tod und Behinderung. Es betrifft eine von drei Personen in den entwickelten Ländern und wird durch die Blockierung der Durchblutung des Herzens verursacht, was zum Absterben der Herzmuskelzellen führt. Die schnelle Identifizierung des Herzinfarktes ist für den Beginn einer wirksamen Behandlung entscheidend. Die Elektrokardiographie und Bluttests, welche den Spiegel des Herztroponins messen - ein Protein was nur im Herz vorkommt, und welches als Folge von Herzmuskelzellschäden in den Kreislauf gelangt - bilden die aktuellen Diagnosen-Eckpfeiler und ergänzen die klinische Beurteilung. Die Entwicklung von hochempfindlichen Herztroponin-Tests, welche im Vergleich zu Tests von früheren Generationen in der Lage sind, Troponin bei viel geringeren Konzentrationen nachzuweisen, haben neue Möglichkeiten der Frühdiagnose, insbesondere die Entwicklung von 1h-Algorithmen, mit denen innerhalb 1h bei der Mehrzahl der Patienten, der Herzinfarkt entweder sicher ausgeschlossen oder nachgewiesen werden kann, ermöglicht.

 Ziele: Die Ziele der aktuellen Studie ist es, die Sicherheit und Effizienz der 1h-Algorithmen in einer Validierungskohorte zu überprüfen.
 Methodik: Wir werden fortlaufend Patienten rekrutieren, welche sich mit akuten Brustschmerzen in der Notaufnahme melden. Ein standardisierter Fragebogen wird dann ausgefüllt, Blutproben werden zu Beginn der Studie, sowie nach 1h, 2h, und 3h genommen und klinische Aufzeichnungen werden gesammelt.  Die endgültige Diagnose (= die wirkliche Ursache für akute Schmerzen in der Brust) wird durch zwei unabhängige Kardiologen gegeben, welche von allen Informationen Gebrauch machen werden, welche die einzelne Patienten betreffen.

 Mögliche Bedeutung: Diese Studie wird Erkenntnisse bieten, welche zur Verbesserung der Frühdiagnose des akuten Myokardinfarkts (AMI) beitragen werden, demzufolge wichtige klinische und wirtschaftliche Auswirkungen auf das Patientenmanagement haben.

Direct link to Lay Summary Last update: 07.04.2015

Responsible applicant and co-applicants

Employees

Publications

Publication
Early Diagnosis of Myocardial Infarction With Point-of-Care High-Sensitivity Cardiac Troponin I
Boeddinghaus Jasper, Nestelberger Thomas, Koechlin Luca, Wussler Desiree, Lopez-Ayala Pedro, Walter Joan Elias, Troester Valentina, Ratmann Paul David, Seidel Funda, Zimmermann Tobias, Badertscher Patrick, Wildi Karin, Rubini Giménez Maria, Potlukova Eliska, Strebel Ivo, Freese Michael, Miró Òscar, Martin-Sanchez F. Javier, Kawecki Damian, Keller Dagmar I., Gualandro Danielle M., Christ Michael, Twerenbold Raphael, Mueller Christian (2020), Early Diagnosis of Myocardial Infarction With Point-of-Care High-Sensitivity Cardiac Troponin I, in Journal of the American College of Cardiology, 75(10), 1111-1124.
Clinical Use of a New High-Sensitivity Cardiac Troponin I Assay in Patients with Suspected Myocardial Infarction
Boeddinghaus Jasper, Twerenbold Raphael, Nestelberger Thomas, Koechlin Luca, Wussler Desiree, Meier Mario, Troester Valentina, Zimmermann Tobias, Badertscher Patrick, Wildi Karin, Rubini Giménez Maria, Lopez-Ayala Pedro, Potlukova Eliska, Miró Òscar, Martin-Sanchez F Javier, Kawecki Damian, Geigy Nicolas, Keller Dagmar I, Reichlin Tobias, Mueller Christian (2019), Clinical Use of a New High-Sensitivity Cardiac Troponin I Assay in Patients with Suspected Myocardial Infarction, in Clinical Chemistry, 65(11), 1426-1436.
Diagnosis of acute myocardial infarction in the presence of left bundle branch block
Nestelberger Thomas, Cullen Louise, Lindahl Bertil, Reichlin Tobias, Greenslade Jaimi H, Giannitsis Evangelos, Christ Michael, Morawiec Beata, Miro Oscar, Martín-Sánchez Francisco Javier, Wussler Desiree Nadine, Koechlin Luca, Twerenbold Raphael, Parsonage William, Boeddinghaus Jasper, Rubini Gimenez Maria, Puelacher Christian, Wildi Karin, Buerge Tobias, Badertscher Patrick, DuFaydeLavallaz Jeanne, Strebel Ivo, Croton Lukas, Bendig Garnet, Osswald Stefan, Pickering John William, Than Martin, Mueller Christian (2019), Diagnosis of acute myocardial infarction in the presence of left bundle branch block, in Heart, 105(20), 1559-1567.
Predicting Major Adverse Events in Patients With Acute Myocardial Infarction
Nestelberger Thomas, Boeddinghaus Jasper, Wussler Desiree, Twerenbold Raphael, Badertscher Patrick, Wildi Karin, Miró Òscar, López Beatriz, Martin-Sanchez F. Javier, Muzyk Piotr, Koechlin Luca, Baumgartner Benjamin, Meier Mario, Troester Valentina, Rubini Giménez Maria, Puelacher Christian, du Fay de Lavallaz Jeanne, Walter Joan, Kozhuharov Nikola, Zimmermann Tobias, Gualandro Danielle M., Michou Eleni, Potlukova Eliska, Geigy Nicolas, Keller Dagmar, Reichlin Tobias, Mueller Christian (2019), Predicting Major Adverse Events in Patients With Acute Myocardial Infarction, in Journal of the American College of Cardiology, 74(7), 842-854.
Early Diagnosis of Myocardial Infarction in Patients With a History of Coronary Artery Bypass Grafting
Koechlin Luca, Boeddinghaus Jasper, Nestelberger Thomas, Wussler Desiree, Walter Joan, Martin-Sanchez F. Javier, Geigy Nicolas, Keller Dagmar I., Twerenbold Raphael, Mueller Christian (2019), Early Diagnosis of Myocardial Infarction in Patients With a History of Coronary Artery Bypass Grafting, in Journal of the American College of Cardiology, 74(4), 587-589.
High-Sensitivity Cardiac Troponin I Assay for Early Diagnosis of Acute Myocardial Infarction
Boeddinghaus Jasper, Nestelberger Thomas, Twerenbold Raphael, Koechlin Luca, Meier Mario, Troester Valentina, Wussler Desiree, Badertscher Patrick, Wildi Karin, Puelacher Christian, du Fay de Lavallaz Jeanne, Rubini Giménez Maria, Zimmermann Tobias, Hafner Benjamin, Potlukova Eliska, Miró Òscar, Martin-Sanchez F Javier, Keller Dagmar I, Reichlin Tobias, Mueller Christian (2019), High-Sensitivity Cardiac Troponin I Assay for Early Diagnosis of Acute Myocardial Infarction, in Clinical Chemistry, 65(7), 893-904.
Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction
Twerenbold Raphael, Costabel Juan Pablo, Nestelberger Thomas, Campos Roberto, Wussler Desiree, Arbucci Rosina, Cortes Marcia, Boeddinghaus Jasper, Baumgartner Benjamin, Nickel Christian H., Bingisser Roland, Badertscher Patrick, Puelacher Christian, du Fay de Lavallaz Jeanne, Wildi Karin, Rubini Giménez Maria, Walter Joan, Meier Mario, Hafner Benjamin, Lopez Ayala Pedro, Lohrmann Jens, Troester Valentina, Koechlin Luca, Zimmermann Tobias, Gualandro Danielle, Reichlin Tobias, Lambardi Florencia, Resi Silvana, Alves de Lima Alberto, Trivi Marcelo, Mueller Christian (2019), Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction, in Journal of the American College of Cardiology, 74(4), 483-494.
Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction
Boeddinghaus Jasper, Nestelberger Thomas, Twerenbold Raphael, Neumann Johannes Tobias, Lindahl Bertil, Giannitsis Evangelos, Sörensen Nils Arne, Badertscher Patrick, Jann Janina E, Wussler Desiree, Puelacher Christian, Rubini Giménez Maria, Wildi Karin, Strebel Ivo, Du Fay de Lavallaz Jeanne, Selman Farah, Sabti Zaid, Kozhuharov Nikola, Potlukova Eliska, Rentsch Katharina, Miró Òscar, Martin-Sanchez F Javier, Morawiec Beata, Parenica Jiri, Lohrmann Jens, Kloos Wanda, Buser Andreas, Geigy Nicolas, Keller Dagmar, Osswald Stefan, Reichlin Tobias, Westermann Dirk, Blankenberg Stefan, Mueller Christian (2018), Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction, in European Heart Journal, 39(42), 3780-3794.
Clinical Validation of a Novel High-Sensitivity Cardiac Troponin I Assay for Early Diagnosis of Acute Myocardial Infarction
Boeddinghaus Jasper, Twerenbold Raphael, Nestelberger Thomas, Badertscher Patrick, Wildi Karin, Puelacher Christian, du Fay de Lavallaz Jeanne, Keser Elif, Rubini Giménez Maria, Wussler Desiree, Kozhuharov Nikola, Rentsch Katharina, Miró Òscar, Martin-Sanchez F Javier, Morawiec Beata, Stefanelli Sabrina, Geigy Nicolas, Keller Dagmar I, Reichlin Tobias, Mueller Christian (2018), Clinical Validation of a Novel High-Sensitivity Cardiac Troponin I Assay for Early Diagnosis of Acute Myocardial Infarction, in Clinical Chemistry, 64(9), 1347-1360.
Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction
Twerenbold Raphael, Neumann Johannes Tobias, Sörensen Nils Arne, Ojeda Francisco, Karakas Mahir, Boeddinghaus Jasper, Nestelberger Thomas, Badertscher Patrick, Rubini Giménez Maria, Puelacher Christian, Wildi Karin, Kozhuharov Nikola, Breitenbuecher Dominik, Biskup Ewelina, du Fay de Lavallaz Jeanne, Flores Dayana, Wussler Desiree, Miró Òscar, Martín Sánchez F. Javier, Morawiec Beata, Parenica Jiri, Geigy Nicolas, Keller Dagmar I., Zeller Tanja, Reichlin Tobias, Blankenberg Stefan, Westermann Dirk, Mueller Christian (2018), Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of Myocardial Infarction, in Journal of the American College of Cardiology, 72(6), 620-632.
Direct Comparison of the 0/1h and 0/3h Algorithms for Early Rule-Out of Acute Myocardial Infarction
Badertscher Patrick, Boeddinghaus Jasper, Twerenbold Raphael, Nestelberger Thomas, Wildi Karin, Wussler Desiree, Schwarz Jonas, Puelacher Christian, Rubini Giménez Maria, Kozhuharov Nikola, du Fay de Lavallaz Jeanne, Cerminara Sara Elisa, Potlukova Eliska, Rentsch Katharina, Miró Òscar, López Beatriz, Martin-Sanchez F. Javier, Morawiec Beata, Muzyk Piotr, Keller Dagmar I., Reichlin Tobias, Mueller Christian (2018), Direct Comparison of the 0/1h and 0/3h Algorithms for Early Rule-Out of Acute Myocardial Infarction, in Circulation, 137(23), 2536-2538.
Impact of the US Food and Drug Administration-Approved Sex-Specific Cutoff Values for High-Sensitivity Cardiac Troponin T to Diagnose Myocardial Infarction.
Rubini Gimenez Maria, Badertscher Patrick, Twerenbold Raphael, Boeddinghaus Jasper, Nestelberger Thomas, Wussler Desiree, Miró Òscar, Martín-Sánchez F Javier, Reichlin Tobias, Mueller Christian (2018), Impact of the US Food and Drug Administration-Approved Sex-Specific Cutoff Values for High-Sensitivity Cardiac Troponin T to Diagnose Myocardial Infarction., in Circulation, 137(17), 1867-1869.
0/1-Hour Triage Algorithm for Myocardial Infarction in Patients With Renal Dysfunction.
Twerenbold Raphael, Badertscher Patrick, Boeddinghaus Jasper, Nestelberger Thomas, Wildi Karin, Puelacher Christian, Sabti Zaid, Rubini Gimenez Maria, Tschirky Sandra, du Fay de Lavallaz Jeanne, Kozhuharov Nikola, Sazgary Lorraine, Mueller Deborah, Breidthardt Tobias, Strebel Ivo, Flores Widmer Dayana, Shrestha Samyut, Miró Òscar, Martín-Sánchez F Javier, Morawiec Beata, Parenica Jiri, Geigy Nicolas, Keller Dagmar I, Rentsch Katharina, von Eckardstein Arnold, Osswald Stefan, Reichlin Tobias, Mueller Christian (2018), 0/1-Hour Triage Algorithm for Myocardial Infarction in Patients With Renal Dysfunction., in Circulation, 137(5), 436-451.

Collaboration

Group / person Country
Types of collaboration
Siemens, Erlangen - Dr. Alessandro Ortisi Germany (Europe)
- Industry/business/other use-inspired collaboration
Klinikum Nürnberg - Prof. Michael Christ Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel
Hospital del Mar, University Barcelona - Professor Joaquim Gea Spain (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel
University Hospital Brno - Prof. Jiri Parenica Czech Republic (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel
Public Research Center for Health, Luxemburg - Dr. Yvan Deveaux Luxembourg (Europe)
- Publication
Hospital Clínic Barcelona - Professor Oscar Miró Spain (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel
Beckman Coulter, Inc., Brea - Sherry Faye United States of America (North America)
- Industry/business/other use-inspired collaboration
Geneva University Hospital, Geneva - Prof. Nicolas Vuilleumier Switzerland (Europe)
- Publication
Instituto Cardiovascular Buenos Aires - Prof. Juan Pablo Costabel Argentina (South America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
University Clinic Hamburg-Eppendorf - Prof. Stefan Blankenberg Germany (Europe)
- Publication
- Research Infrastructure
BRAHMS, Henningsdorf - Dr. Ole Vollert Germany (Europe)
- Industry/business/other use-inspired collaboration
Kantonsspital Olten - Professor Stefano Bassetti Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel
University Genoa - Paolo Ballarino, MD Italy (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel
Royal Brisbane and Women's Hospital, Brisbane - Prof. Louise Cullen Australia (Oceania)
- Publication
Klinik St. Anna Luzern - Prof. Paul Erne Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel
Christchurch Hospital, Christchurch - Prof. Martin Than New Zealand (Oceania)
- Publication
University Hospital Zürich - Prof. Thomas Lüscher Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel
Roche Diagnostics, Rotkreuz - Prof. Christian Zaugg Switzerland (Europe)
- Industry/business/other use-inspired collaboration
ECPM, University Basel - PD Matthias Schwenkglenks Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Hospital Clinico San Carlos Madrid - Prof. Francisco Javier Martin Sanchez Spain (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Abbott Diagnostics, Wiesbaden - Dr. Lieselotte Lennartz Germany (Europe)
- Industry/business/other use-inspired collaboration
Kantonsspital Luzern - Stephan Steuer, MD Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel

Scientific events



Self-organised

Title Date Place
International GREAT Meeting 06.07.2017 Barcelona, Spain

Communication with the public

Communication Title Media Place Year
Media relations: print media, online media CRIB today videos International 2016

Awards

Title Year
Otto Hess Award of the SGK 2018 to Patrick Badertscher Otto Hess Award of the SGK 2018 to Thomas Nestelberger Otto Hess Award of the SGK 2018 to Christian Puelacher Amgen SGK Award 2018 to Raphael Twerenbold Otto Hess Award of the SGK 2015 to Maria Rubini 2018

Associated projects

Number Title Start Funding scheme
135434 Advantageous Predictors of Acute Coronary Syndromes Evaluation (APACE) Study 01.04.2011 Project funding (Div. I-III)

Abstract

Acute myocardial infarction (AMI) is a major cause of death and disability. Rapid identification of AMI is critical for the initiation of effective treatment and management. Electrocardiography (ECG) and cardiac troponin (cTn) form the current diagnostic cornerstones and complement clinical assessment. The development of high-sensitivity cardiac troponin (hs-cTn) and copeptin assays and their initial clinical evaluation constitute the most important advances in the early diagnosis of AMI in recent years. Data from several groups including ours have helped to highlight their clinical potential. This includes the development of early rule-out and early rule-in algorithms. However, several important questions remain regarding these algorithms, including the observation that they will need to be assay-specific and have to be validated in a very large prospective validation cohort, before they can be recommended for widespread clinical use. The objectives of the current application are to extend the work in the ongoing and highly successful APACE study in order to provide additional insights for the refinements of the early diagnosis of AMI. Specifically, in the new application period we will a) increase the total number of recruited patients to 6000; b) validate the efficacy and safety of our recently developed 1h-hs-cTnT algorithm; c) derive and validate a new 1h-hs-cTnT algorithm incorporating the concept of very low/undetectable levels of hs-cTnT; d) derive and validate new 1h-hs-cTnI algorithms incorporating very low/undetectable levels of hs-cTnI and early changes using different assays e) derive and validate new 2h hs-cTnT and hs-cTnI algorithms (all previously mentioned assays); f) validate the recently developed accelerated diagnostic protocol combining a clinical score, ECG and hs-cTn at 0h and 2h for early rule-out; g) evaluate the accuracy of the current ESC 3h rule-out algorithm; h) derive and validate new 1h algorithms combining hs-cTn (all assays) and copeptin; i) derive and validate new 0h algorithms combining hs-cTn (all assays) and copeptin; j) directly compare the diagnostic accuracy of different hs-cTn assays at presentation as well as during serial sampling; k) evaluate whether the diagnostic accuracy of hs-cTn assays depends on the clinical likelihood for the presence of an acute coronary syndrome; l) determine the potential impact of hs-cTn and copeptin on resource use and costs; m) determine the potential effect of the clinical application of hs-cTnT on patient mortality as well as use of cardiac investigations length of stay, and costs; n) evaluate the diagnostic performance and derive + validate optimal clinical decision values of hs-cTn assays in underappreciated subgroups o) quantify and compare gender-specific diagnostic uncertainty among physicians evaluating women and men with suspected AMI; p) evaluate the utility, diagnostic accuracy, and impact on the incidence of AMI of gender-specific 99th percentiles as clinical decision values; q) explore remaining sources for misdiagnosis of AMI after the introduction of the “universal definition” of AMI and to quantify inconsistencies in the diagnosis of AMI related to the limitations of the current process on how to define the 99th percentile of hs-cTn assays; r) explore the release ratio and the linearity of release of cTnI and cTnT in AMI as well as noncardiac chest pain.This study will provide insights that will contribute to improvements in the early diagnosis of AMI and will therefore have important clinical and economic implications on patient management in Switzerland and worldwide.
-