{"id":"a4ab18e63b88","type":"article","url":"https://hartvaat.nl/2026/01/06/machine-learning-algoritme-mi3-helpt-een-infarct-uitsluiten-bij-een-onduidelijke/","title":"Machine-learning-algoritme MI3 helpt een infarct uitsluiten bij een onduidelijke troponinewaarde","title_en":"Diagnostic performance of the Myocardial-Ischaemic-Injury index machine-learning algorithm in patients with an initial indeterminate troponin","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["myocardinfarct","troponine"],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003767?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003767?rss=1","authors":["Snavely","A. C.","Hunter","C. J.","Jackson","L.","Stopyra","J. P.","Ashburn","N. P.","Supples","M. W.","Christenson","R.","Miller","C. D.","Mahler","S. A."],"significance":5,"published":"2026-01-06","source_date":"2026-01-06","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/cardiale-biomarkers-overzicht/","https://hartvaat.nl/kennis/vasculair/d-dimeer-interpretatie/"],"congress":"","summary_en":"Ruling out myocardial infarction in patients with an initially indeterminate (detectable to mildly elevated) troponin is difficult. The Myocardial-Ischaemic-Injury Index (MI3) is a machine-learning algorithm to diagnose infarction. This secondary analysis (207 patients with suspected acute coronary syndrome and an initial troponin of 0.006-1.0 ng/mL, four US hospitals) tested the algorithm, which classifies patients into low, intermediate and high risk based on initial and 3-hour high-sensitivity troponin. Infarction within 30 days occurred in 43.5%. The AUC of MI3 was 0.88. The low-risk group (35%) had 8.3% infarctions (sensitivity 93%, negative likelihood ratio 0.12), whereas the high-risk group had 100% with infarction (specificity 100%). In patients with an indeterminate troponin, the MI3 algorithm thus had high accuracy and specificity for 30-day infarction.","created":"2026-07-03T10:32:29Z","updated":"2026-07-03T13:31:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een hartinfarct uitsluiten bij patiënten met een aanvankelijk onduidelijke (detecteerbare tot licht verhoogde) troponinewaarde is lastig. De Myocardial-Ischaemic-Injury Index (MI3) is een machine-learning-algoritme om een infarct te diagnosticeren. Deze secundaire analyse (207 patiënten met verdenking acuut coronair syndroom en een initiële troponine van 0,006-1,0 ng/ml, vier Amerikaanse ziekenhuizen) toetste het algoritme, dat patiënten op basis van de initiële en 3-uurs hoogsensitieve troponine indeelt in laag, intermediair en hoog risico. Een infarct binnen 30 dagen kwam bij 43,5% voor. De AUC van MI3 was 0,88. De laagrisicogroep (35%) had 8,3% infarcten (sensitiviteit 93%, negatieve likelihood ratio 0,12), terwijl in de hoogrisicogroep 100% een infarct had (specificiteit 100%). Bij patiënten met een onduidelijke troponine had het MI3-algoritme dus een hoge nauwkeurigheid en specificiteit voor een infarct binnen 30 dagen.","abstract_original":"Background\n

Ruling out myocardial infarction (MI) in patients with an initial indeterminate (detectable to mildly elevated) troponin measure is challenging. Myocardial-Ischaemic-Injury Index (MI3) is a machine-learning algorithm designed to diagnose MI, but its utility in patients with indeterminate troponins is unclear. This study seeks to evaluate its diagnostic performance in patients with an initial indeterminate troponin.

\n\nMethods\n

We conducted a secondary analysis of a cohort (Cardiovascular Magnetic Resonance-Invasive-based Strategies in Patients with Chest Pain and Detectable to Mildly Elevated Serum Troponin) of adult patients with symptoms suggestive of acute coronary syndrome and an initial clinical contemporary troponin of 0.006–1.0 ng/mL across four US hospitals. Patients with initial and 3-hour high-sensitivity cardiac troponin I (Abbott Laboratories) measures were classified by MI3 into low-risk, intermediate-risk and high-risk groups. The primary outcome was adjudicated MI at 30 days. The sensitivity, specificity and negative likelihood ratio (–LR) of MI3 for MI at 30 days were calculated and reported with 95% CIs. A receiver operator characteristics curve for MI at 30 days was created and area under the curve (AUC) for MI3 was calculated.

\n\nResults\n

Among 207 patients, 34.3% (71/207) were female with a mean age of 61±11 years. MI at 30 days occurred in 43.5% (90/207). The AUC for MI3 for the detection of MI at 30 days was 0.882 (95% CI 0.833 to 0.932). MI3 classified 34.8% (72/207) of patients as low-risk, of which 8.3% (6/72) had MI at 30 days, yielding a sensitivity of 93.3% (95% CI 86.1 to 97.5%) and –LR of 0.12 (95% CI 0.05 to 0.26). Among the 47.3% (98/207) classified as intermediate-risk, MI at 30 days occurred in 48.0% (47/98). MI3 classified 17.9% (37/207) as high-risk, among which 100% (37/37) had MI at 30 days, yielding a specificity of 100% (95% CI 96.9% to 100%).

\n\nConclusions\n

Among emergency department patients with an initial indeterminate troponin measure, the MI3 machine-learning algorithm had high AUC and specificity for 30-day MI.

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