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. 2021 May 18;10(10):e020031.
doi: 10.1161/JAHA.120.020031. Epub 2021 May 12.

External Validation of the No Objective Testing Rules in Acute Chest Pain

Paul David Ratmann  1   2 , Jasper Boeddinghaus  1   2 , Thomas Nestelberger  1   2 , Pedro Lopez-Ayala  1   2 , Luca Koechlin  1   2   3 , Karin Wildi  1   2   4   5 , Oscar Miro  1   2   6 , F Javier Martín-Sánchez  1   2   7 , Michael Christ  8 , Raphael Twerenbold  1   2 , Maria Rubini Gimenez  1   9 , Dagmar I Keller  10 , Christian Mueller  1   2 ; Advantageous Predictors of Acute Coronary Syndrome Evaluation Investigators †
Collaborators, Affiliations

External Validation of the No Objective Testing Rules in Acute Chest Pain

Paul David Ratmann et al. J Am Heart Assoc. .
No abstract available

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Conflict of interest statement

Dr Boeddinghaus has received research grants from the University of Basel, the University Hospital of Basel, the Division of Internal Medicine, the Swiss Academy of Medical Sciences, and the Gottfried and Julia Bangerter‐Rhyner Foundation; and has received speaker honoraria and/or consulting honoraria from Siemens, Roche Diagnostics, Ortho Clinical Diagnostics, and Quidel Corporation. Dr Nestelberger has received research support from the Swiss National Science Foundation (P400PM_191037/1), the Prof Dr Max Cloëtta Foundation, the Margarete und Walter Lichtenstein‐Stiftung (3MS1038), and the University Hospital Basel as well as speaker honoraria/consulting honoraria from Siemens, Beckman Coulter, Bayer, Ortho Clinical Diagnostics and Orion Pharma, outside the submitted work. Dr Koechlin received a research grant from the University of Basel, the Swiss Academy of Medical Sciences, and the Gottfried and Julia Bangerter‐Rhyner Foundation, as well as the “Freiwillige Akademische Gesellschaft Basel.” Dr Wildi has received research support from the Gottfried and Julia Bangerter‐Rhyner Stiftung, The Prince Charles Hospital Foundation, the CRE Actions Fund (National Health and Medical Research Council), and the University of Queensland, all outside of the submitted work. Dr Miro received grants from the Instituto de Salud Carlos III, supported with funds from the Spanish Ministry of Health and Fondo Europeo de Desarollo Regional (PI10/01918, PI11/01021, PI15/01019, and PI15/00773), La Marató de TV3 (2015/2510), and the Catalonian Government for Consolidated Groups of Investigation (GRC 2009/1385, 2014/0313, and 2017/1424). Dr Rubini Gimenez reports research grants from Swiss National Science Foundation (P400PM_180828) and from the Swiss Heart Foundation and speakers/advisors’ honoraria from Roche, Ortho Clinical Diagnostics, Abbott, and Siemens. Dr Mueller has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the KTI, the European Union, the University of Basel, the University Hospital Basel, the Stiftung für kardiovaskuläre Forschung Basel, Abbott, Beckman Coulter, Biomerieux, Idorsia, Ortho Cinical Diagnostics, Quidel, Roche, Siemens, Singulex, and Sphingotec, as well as speaker honoraria/consulting honoraria from Acon, Amgen, Astra Zeneca, Boehringer Ingelheim, Bayer, BMS, Idorsia, Novartis, Osler, Roche, and Sanofi, outside of the submitted work. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. External validation of the NOT rules and application with a well‐validated 0/2‐hour algorithm.
A, Validation of the performance of NOT rules for rule out of MACEs at 30 days, including index events. B, Performance of NOT rules for rule out of MACEs at 30 days, including index events after rule out of AMI with a well‐validated 0/2‐hour algorithm. 4 The second and third rules best balance safety and efficacy for the rule out of ACS or cardiovascular death. They safely classify nearly one fourth of patients at low risk who may not need objective cardiac testing. Groups and MACEs (ACS or cardiovascular death) are presented as numbers and percentages. NPV and sensitivity are presented as percentages. Risk factors include hypertension, dyslipidemia, current or previous smoking, diabetes mellitus, and family history of coronary artery disease. CAD indicates coronary artery disease; Hs‐cTnI, Abbott Architect high‐sensitivity cardiac troponin I; and MI, myocardial infarction. ACS indicates acute coronary syndrome; AMI, acute myocardial infarction; MACE, major adverse cardiovascular event; NOT, No Objective Testing; and NPV, negative predictive value.
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References

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