title: Immediate Rule-Out of Acute Myocardial Infarction Using Electrocardiogram and Baseline High-Sensitivity Troponin I.
abstract: OBJECTIVE
  Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG) to rule out AMI.
  
  
  METHODS
  Troponin I measured with a high-sensitivity assay (hs-TnI) was determined at admission in 1040 patients presenting with suspected AMI (BACC study). To rule out AMI we calculated the negative predictive value (NPV) utilizing the optimal hs-TnI cutoff combined with a low risk ECG. The results were validated in 3566 patients with suspected AMI [2-h Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) studies]. Patients were followed for 6 or 12 months.
  
  
  RESULTS
  184 of all patients were diagnosed with AMI. An hs-TnI cutoff of 3 ng/L resulted in a NPV of 99.3% (CI 97.3-100.0), ruling out 35% of all non-AMI patients. Adding the information of a low risk ECG resulted in a 100% (CI 97.5-100.0) NPV (28% ruled out). The 2 validation cohorts replicated the high NPV of this approach. The follow-up mortality in the ruled out population was low (0 deaths in BACC and Stenocardia, 1 death in ADAPT).
  
  
  CONCLUSIONS
  A single hs-TnI measurement on admission combined with a low risk ECG appears to rule out AMI safely without need for serial troponin testing.
  
  
  BACKGROUND
  www.clinicaltrials.gov (NCT02355457).
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany; j.neumann@uke.de.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
authors.forename: Johannes Tobias
authors.initials: JT
authors.lastname: Neumann
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Nils Arne
authors.initials: NA
authors.lastname: Sörensen
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ojeda
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Tjark
authors.initials: T
authors.lastname: Schwemer
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Jonas
authors.initials: J
authors.lastname: Lehmacher
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Saskia
authors.initials: S
authors.lastname: Gönner
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Nikolas
authors.initials: N
authors.lastname: Jarsetz
authors.affiliation: Department of Cardiology, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Keller
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
authors.forename: Sarina
authors.initials: S
authors.lastname: Schaefer
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany and Clinical Chemistry, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Renné
authors.affiliation: Department of Cardiology, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.|Department of Medicine, Nykoebing F Hospital, University of Southern Denmark, Odense, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
authors.forename: Nataliya
authors.initials: N
authors.lastname: Makarova
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
authors.forename: Renate B
authors.initials: RB
authors.lastname: Schnabel
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
authors.forename: Mahir
authors.initials: M
authors.lastname: Karakas
authors.affiliation: Emergency Department, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: John W
authors.initials: JW
authors.lastname: Pickering
authors.affiliation: Emergency Department, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Martin
authors.initials: M
authors.lastname: Than
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Parsonage
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: Jaimi
authors.initials: J
authors.lastname: Greenslade
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Westermann
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I