Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department.
The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial.



Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013. Measurements of hs-cTnT (99th percentile, 14 ng/L) were performed at 0, 1, 2, and 4 to 14 hours. Evaluation for major adverse cardiac events (MACEs) occurred at 30 days (death or AMI). Low-risk patients had an m-HS≤3 and had either hs-cTnT<14 ng/L over serial testing or had AMI excluded by the 1-hour protocol. By the 1-hour protocol, 777 (60%) patients had an AMI excluded. Of those 777 patients, 515 (66.3%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 262 (33.7%) patients had an m-HS≥4, with 6 (2.3%) patients having MACEs (P=0.007). Over 4 to 14 hours, 661 patients had a hs-cTnT<14 ng/L. Of those 661 patients, 413 (62.5%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 248 (37.5%) patients had an m-HS≥4, with 5 (2.0%) patients having MACEs (P=0.03).



Serial testing of hs-cTnT over 1 hour along with application of an m-HS identified a low-risk population that might be able to be directly discharged from the emergency department.
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.). jmccord1@hfhs.org.
James
J
McCord
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Rafael
R
Cabrera
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Bertil
B
Lindahl
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Evangelos
E
Giannitsis
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Kaleigh
K
Evans
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Richard
R
Nowak
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Tiberio
T
Frisoli
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Richard
R
Body
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Michael
M
Christ
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Christopher R
CR
deFilippi
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Robert H
RH
Christenson
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Gordon
G
Jacobsen
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Aitor
A
Alquezar
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Mauro
M
Panteghini
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Dina
D
Melki
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Mario
M
Plebani
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Franck
F
Verschuren
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
John
J
French
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Garnet
G
Bendig
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Silvia
S
Weiser
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Christian
C
Mueller
D000328:Adult; D000368:Aged; D000465:Algorithms; D000787:Angina Pectoris / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D001315:Australia; D015415:Biomarkers / Q000097:blood; D016507:Cardiology Service, Hospital; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D020107:Troponin T / Q000097:blood*; D014481:United States; D015854:Up-Regulation
D015415:Biomarkers; D020107:Troponin T
mortality; myocardial i; nfarction; patient discharge; prognosis; troponin-T