title: Normal presenting levels of high-sensitivity troponin and myocardial infarction.
abstract: OBJECTIVE
  To analyse whether levels of high-sensitivity cardiac troponin (hs-cTn) below their respective 99th percentile can be used as a single parameter to rule out acute myocardial infarction (AMI) at presentation.
  
  
  METHODS
  Prospective, multicentre study.
  
  
  METHODS
  We measured hs-cTn using four different methods (hs-cTnT Roche, hs-cTnI Siemens, hs-cTnI Beckman Coulter and hs-cTnI Abbott) in consecutive patients presenting to the emergency department with acute chest pain. Two independent cardiologists adjudicated the final diagnosis. Patients were followed for death or AMI during a mean period of 24 months.
  
  
  RESULTS
  Among 2072 consecutive patients with hs-cTnT measurements available, 21.4% had an adjudicated diagnosis of AMI (sensitivity 89.6%, 95% CI 86.4% to 92.3%, negative predictive value (NPV): 96.5%, 95% CI 95.4% to 97.4%). Among 1180 consecutive patients with hs-cTnI Siemens measurements available, 20.0% had AMI (sensitivity 94.1%, 95% CI 90.3% to 96.7%, NPV: 98.0%, 95% CI: 96.6% to 98.9%). Among 1151 consecutive patients with hs-cTnI Beckman Coulter measurements available, 19.7% had AMI (sensitivity 92.1%, 95% CI 87.8% to 95.2%, NPV: 97.5%, 95% CI 96.0% to 98.5%). Among 1567 consecutive patients with hs-cTnI Abbott measurements available, 20.0% had AMI (sensitivity 77.2%, 95% CI 72.1% to 81.7%, NPV: 94.3%, 95% CI 92.8% to 95.5%).
  
  
  CONCLUSIONS
  Normal hs-cTn levels at presentation should not be used as a single parameter to rule out AMI as 6%-23% of adjudicated AMI cases had normal levels of hs-cTn levels at presentation. Our data highlight the lack of standardisation among hs-cTnI assays resulting in substantial differences in sensitivity and NPV at the 99th percentile.
authors.affiliation: Department of Cardiology, University Hospital Basel, , Basel, Switzerland.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Hoeller
authors.forename: María
authors.initials: M
authors.lastname: Rubini Giménez
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.forename: Christa
authors.initials: C
authors.lastname: Zellweger
authors.forename: Berit
authors.initials: B
authors.lastname: Moehring
authors.forename: Karin
authors.initials: K
authors.lastname: Wildi
authors.forename: Michael
authors.initials: M
authors.lastname: Freese
authors.forename: Claudia
authors.initials: C
authors.lastname: Stelzig
authors.forename: Beate
authors.initials: B
authors.lastname: Hartmann
authors.forename: Melanie
authors.initials: M
authors.lastname: Stoll
authors.forename: Tamina
authors.initials: T
authors.lastname: Mosimann
authors.forename: Miriam
authors.initials: M
authors.lastname: Reiter
authors.forename: Philip
authors.initials: P
authors.lastname: Haaf
authors.forename: Mira
authors.initials: M
authors.lastname: Mueller
authors.forename: Bernadette
authors.initials: B
authors.lastname: Meller
authors.forename: Thomas
authors.initials: T
authors.lastname: Hochgruber
authors.forename: Cathrin
authors.initials: C
authors.lastname: Balmelli
authors.forename: Seoung Mann
authors.initials: SM
authors.lastname: Sou
authors.forename: Karsten
authors.initials: K
authors.lastname: Murray
authors.forename: Heike
authors.initials: H
authors.lastname: Freidank
authors.forename: Stephan
authors.initials: S
authors.lastname: Steuer
authors.forename: Jan
authors.initials: J
authors.lastname: Minners
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D005060:Europe; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D013997:Time Factors; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; C545568:TNNT2 protein, human; D019210:Troponin I; D020107:Troponin T
keywords: CORONARY ARTERY DISEASE