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Word of the Day

Negative high-sensitivity troponin rules out AMI

Clinical Question:
Can initially undetectable high-sensitivity troponin effectively rule-out acute myocardial infarction?

Bottom Line:
High-sensitivity troponin T assay (hs-cTnT) has a very high-sensitivity (99.98% - 100%) and a single negative result at the time of presentation effectively rules out acute myocardial infarction (AMI). (LOE = 1b)

Reference:
Body R, Carley S, McDowell G, et al. Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a high-sensitivity assay. J Am Coll Cardiol 2011;58(13):1332-1339.  [PMID:21920261]

Study Design:
Cohort (prospective)

Funding:
Industry

Setting:
Various (meta-analysis)

Synopsis:
In the first part of this 2-part study, the authors enrolled 703 patients presenting to a British emergency department with chest pain that may have been cardiac in nature. At the time of presentation blood was drawn and later analyzed for troponin using hs-cTnT by a laboratory masked to patient outcomes. These results were compared with a diagnosis of AMI by 2 investigators unaware of the troponin results. AMI was diagnosed in 18.5% of patients. No patients with an hs-cTnT of less than 3 ng/L at the time of presentation had AMI (sensitivity = 100%; 95% CI, 97.2% - 100%). In the second aspect of the study, the hs-cTnT was introduced as part of clinical practice and was drawn in 915 patients at presentation and again within 12 hours. For these patients, only 1 with an initial hs-cTnT of less than 3 ng/L had an elevation 12 hours later (sensitivity = 99.8%; 99.1% - 100%). This patient presented 1 hour after symptom onset; the mean time to presentation in the group was 3 hours.

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