In Search of the 1-Hour Rule-Out for Acute Myocardial Infarction.
Old habits die hard. The study by Hillinger et al. provides a framework for several observations regarding the current state of ADPs for rapid rule-out of ACS. ADPs that incorporate serial assessments of high-sensitivity cardiac troponin appear to provide a viable approach to rule out ACS with sampling over 3 h with a high NPV. The actual interval (1, 2, or 3 h) and optimal thresholds are issues still to be refined for each assay. A dual-marker strategy using copeptin does not provide incremental clinical information beyond high-sensitivity cardiac troponin, and it seems unlikely that other biomarkers will substantially improve the NPV achieved with serial high-sensitivity cardiac troponin testing alone.
TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Benjamin M
BM
Scirica
TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. dmorrow@partners.org.
David A
DA
Morrow
D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D006020:Glycopeptides; D020107:Troponin T; C048197:copeptins