title: Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients.
abstract: BACKGROUND
  We aimed to evaluate the efficacy and safety of using high-sensitivity cardiac troponin T (hs-cTnT) within an accelerated diagnostic protocol (ADP) in patients presenting with symptoms suggestive of acute myocardial infarction (AMI) for rapid rule-out of AMI.
  
  
  METHODS
  In two independent large multicenter studies, levels of hs-cTnT at presentation and at 2 h were combined with the Thrombolysis In Myocardial Infarction (TIMI) risk score and ECG findings. The ADP defined patients with normal levels of hs-cTnT at presentation and 2 h, a TIMI score ≤1, and normal ECG findings as candidates for rapid rule-out of AMI and rapid discharge. Major adverse cardiac events (MACEs) occurring within 30-days were centrally adjudicated by two independent cardiologists.
  
  
  RESULTS
  In the derivation cohort, among 1085 consecutive patients 198 patients (18.2%) had a MACE. The ADP classified 374 patients (34.5%) as low-risk. None of these patients had a MACE at 30 days, resulting in a negative predictive value (NPV) of 100% (95% CI, 99.0-100%) and a sensitivity of 100% (95% CI, 98.2%-100%). In the validation cohort, among 1590 consecutive patients 231 patients (14.5%) had a MACE. The ADP classified 641 patients (40.3%) as low-risk. 6 of these patients had a MACE at 30 days, resulting in a NPV of 99.1% (95% CI, 98.0-99.6%) and a sensitivity of 97.4% (95% CI, 94.5-98.8%).
  
  
  CONCLUSIONS
  The ADP including hs-cTnT allows early identification 35 to 40% of patients to be at extremely low risk of MACE and therefore ideal candidates for outpatient management.
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Meller
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
authors.affiliation: Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: William A
authors.initials: WA
authors.lastname: Parsonage
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Jaimi H
authors.initials: JH
authors.lastname: Greenslade
authors.affiliation: Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Sally
authors.initials: S
authors.lastname: Aldous
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Karin
authors.initials: K
authors.lastname: Wildi
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Cedric
authors.initials: C
authors.lastname: Jaeger
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Petra
authors.initials: P
authors.lastname: Hillinger
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Philip
authors.initials: P
authors.lastname: Haaf
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Puelacher
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Vera
authors.initials: V
authors.lastname: Kern
authors.affiliation: Department of Laboratory Medicine, University Hospital, Basel, Switzerland.
authors.forename: Katharina
authors.initials: K
authors.lastname: Rentsch
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Fabio
authors.initials: F
authors.lastname: Stallone
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar, Institut Municipal d'Investigació Mèdica, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Rubini Gimenez
authors.affiliation: Emergency Department, San Martino University Hospital, Genoa, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Ballarino
authors.affiliation: Kantonsspital Olten, Switzerland.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bassetti
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Astrid
authors.initials: A
authors.lastname: Walukiewicz
authors.affiliation: Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
authors.forename: Richard
authors.initials: R
authors.lastname: Troughton
authors.affiliation: Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Pemberton
authors.affiliation: Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
authors.forename: A Mark
authors.initials: AM
authors.lastname: Richards
authors.affiliation: CCRE Therapeutics, Monash University, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Chu
authors.affiliation: CCRE Therapeutics, Monash University, Australia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.affiliation: Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Martin
authors.initials: M
authors.lastname: Than
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland. Electronic address: christian.mueller@usbs.ch.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis; D002637:Chest Pain / Q000097:blood* / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: Acute chest pain; Cardiac troponin; ECG; MACE; TIMI score