Single High-Sensitivity Cardiac Troponin I to Rule Out Acute Myocardial Infarction.
This study examined the performance of single high-sensitivity cardiac troponin I (hs-cTnI) measurement strategies to rule out acute myocardial infarction.



This was a prospective, observational study of consecutive patients presenting to the emergency department (n = 1631) in whom cTnI measurements were obtained using an investigational hs-cTnI assay. The goals of the study were to determine 1) negative predictive value (NPV) and sensitivity for the diagnosis of acute myocardial infarction, type 1 myocardial infarction, and type 2 myocardial infarction; and 2) safety outcome of acute myocardial infarction or cardiac death at 30 days using hs-cTnI less than the limit of detection (LoD) (<1.9 ng/L) or the High-STEACS threshold (<5 ng/L) alone and in combination with normal electrocardiogram (ECG).



Acute myocardial infarction occurred in 170 patients (10.4%), including 68 (4.2%) type 1 myocardial infarction and 102 (6.3%) type 2 myocardial infarction. For hs-cTnI<LoD (27%), the NPV and sensitivity for acute myocardial infarction were 99.6% (95% confidence interval 98.9%-100%) and 98.8 (97.2%-100%). For hs-cTnI<5 ng/L (50%), the NPV and sensitivity for acute myocardial infarction were 98.9% (98.2%-99.6%) and 94.7% (91.3%-98.1%). In combination with a normal ECG, 1) hs-cTnI<LoD had an NPV of 99.6% (98.9%-100%) and sensitivity of 99.4% (98.3%-100%); and 2) hs-cTnI<5 ng/L had an NPV of 99.5% (98.8%-100%) and sensitivity of 98.8% (97.2%-100%). The NPV and sensitivity for the safety outcome were excellent for hs-cTnI<LoD alone or in combination with a normal ECG, and for hs-cTnI<5 ng/L in combination with a normal ECG.



Strategies using a single hs-cTnI alone or in combination with a normal ECG allow the immediate identification of patients unlikely to have acute myocardial infarction and who are at very low risk for adverse events at 30 days.
Division of Cardiology, Hennepin County Medical Center and Minneapolis Heart Institute, Abbott Northwestern Hospital, Minn.
Yader
Y
Sandoval
Department of Emergency Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis.
Stephen W
SW
Smith
Minneapolis Medical Research Foundation, Minn; Department of Laboratory Medicine and Pathology, Hennepin County Medical Center and University of Minnesota, Minneapolis.
Sara A
SA
Love
Minneapolis Medical Research Foundation, Minn.
Anne
A
Sexter
Minneapolis Medical Research Foundation, Minn.
Karen
K
Schulz
Minneapolis Medical Research Foundation, Minn; Department of Laboratory Medicine and Pathology, Hennepin County Medical Center and University of Minnesota, Minneapolis. Electronic address: apple004@umn.edu.
Fred S
FS
Apple
D000208:Acute Disease; D001681:Biological Assay / Q000379:methods; D015415:Biomarkers / Q000097:blood; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D019210:Troponin I
Acute myocardial infarction; High-sensitivity cardiac troponin; Troponin