Two large studies show that troponin levels that are normal at presentation and not increased 1 hour later can rule out myocardial infarction.
Prior research has suggested that negative and nonincreasing high-sensitivity cardiac troponin (hsTn) levels measured at emergency department (ED) presentation and 1 hour later can rule out acute myocardial infarction (MI) in low-risk patients with nonischemic electrocardiograms (NEJM JW Emerg Med Feb 2016 and Ann Emerg Med 2016 Jan 12; [e-pub]). However, the negative predictive value in the cited study was 99.1%, and the sensitivity was 96.7%, meaning that 0.9% of negative tests were wrong and, importantly, 3.3% of MIs were missed. Two new studies assessed the sensitivity of hsTnI when a lower threshold is used.
In the first study, involving 1040 patients with acute chest pain presenting to a single ED in Germany, the outcome was an adjudic…
Reviewing Author
DisclosuresConsultant/Advisory BoardPortola Pharmaceuticals, Inc.
Speaker’s BureauPeerView Institute for Medical Education
Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals
DisclosuresConsultant/Advisory BoardPortola Pharmaceuticals, Inc.
Speaker’s BureauPeerView Institute for Medical Education
Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals