title: Rapid rule out of acute myocardial infarction using undetectable levels of high-sensitivity cardiac troponin.
abstract: BACKGROUND
  We examined whether undetectable levels of high-sensitivity cardiac Troponin (hs-cTn) can be used to rule out acute myocardial infarction (AMI) with a single blood draw at presentation to the emergency department (ED).
  
  
  RESULTS
  In a prospective multicenter study we used 4 different hs-cTn assays (hs-cTnT Roche, and hs-cTnI Siemens, hs-cTnI Beckman Coulter and hs-cTnI Abbott) in consecutive patients presenting with acute chest pain. The final diagnosis of AMI was adjudicated by two independent cardiologists using all available data including serial hs-cTnT levels. Mean follow up was 24 months. Among 2072 consecutive patients with available hs-cTnT levels, 21% had an adjudicated diagnosis of AMI. Among AMI patients, 98.2% had initially detectable levels of hs-cTnT (sensitivity 98.2%, 95%CI 96.3%-99.2%, negative predictive value (NPV) 98.6%, 95%CI 97.0%-99.3%). Undetectable levels of hs-cTnT ruled out AMI in 26.5% of patients at presentation. The NPV was similar with the three hs-cTnI assays: among 1180 consecutive patients with available hs-cTnI (Siemens), the NPV was 98.8%; among 1151 consecutive patients with available hs-cTnI (Beckman Coulter), the NPV was 99.2%; among 1567 consecutive patients with available hs-cTnI (Abbott), the NPV was 100.0%. The percentage of patients with undetectable levels of hs-cTnI was similar among the three hs-cTnI assays and ranged from 11.4% to 13.9%.
  
  
  CONCLUSIONS
  Undetectable levels of hs-cTn at presentation have a very high NPV and seem to allow the simple and rapid rule out of AMI. This criteria applies to much more patients with hs-TnT as compared to the investigated hs-cTnI assays.
authors.affiliation: Department of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Maria
authors.initials: M
authors.lastname: Rubini Giménez
authors.forename: Rebeca
authors.initials: R
authors.lastname: Hoeller
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.forename: Christa
authors.initials: C
authors.lastname: Zellweger
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.forename: Miriam
authors.initials: M
authors.lastname: Reiter
authors.forename: Berit
authors.initials: B
authors.lastname: Moehring
authors.forename: Karin
authors.initials: K
authors.lastname: Wildi
authors.forename: Tamina
authors.initials: T
authors.lastname: Mosimann
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: Ronny
authors.initials: R
authors.lastname: Ziller
authors.forename: Seoung Mann
authors.initials: SM
authors.lastname: Sou
authors.forename: Karsten
authors.initials: K
authors.lastname: Murray
authors.forename: Konstantin
authors.initials: K
authors.lastname: Sakarikos
authors.forename: Susanne
authors.initials: S
authors.lastname: Ernst
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gea
authors.forename: Isabel
authors.initials: I
authors.lastname: Campodarve
authors.forename: Carles
authors.initials: C
authors.lastname: Vilaplana
authors.forename: Philip
authors.initials: P
authors.lastname: Haaf
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; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T
keywords: Acute myocardial infarction; High sensitive cardiac troponin; Rapid rule-out