Consideration of high-sensitivity troponin values below the 99th percentile at presentation: Does it improve diagnostic accuracy?

Early rule-out and rule-in of myocardial infarction using sensitive cardiac Troponin I

“…The small differences seem well explained by the small differences in study design, as the adjudication was based on a different hs-cTn assay in this analysis, while late samples of the same hs-cTnT assay were used in the hs-cTnT pilot study [11]. Thereby, our data extend the concept of an 1 h-algorithm from hs-cTnT also to the thoroughly validated sensitive cTn assay [8,10,[12][13][14][15][16][17][18][19][20][21][22][23]. This is of major clinical importance as this assay is already commonly used in the United States and worldwide.…”

“…As the majority of institutions in the United States and world-wide use sensitive, but not hs-cTn assays, we performed a large multicenter study to derive and validate 1 h-and 2 h-algorithms for rule-out and rule-in of AMI using a thoroughly-examined sensitive cTnI assay [8,10,[12][13][14][15][16][17][18][19][20][21][22][23]. We found overall a similar performance of the 1 h sensitive cTnI algorithm as recently described for the 1 h-hs-cTnT algorithm [11,31] and the 1 h-hs-cTnI algorithm [32] indicating that accurate rule-out and rule-in are feasible much more rapidly than suggested in current AHA/ACC [4] or ESC [5] guidelines in many patients also using sensitive cTn assays.…”

“…In addition, due to poor harmonization among cTn assays, these finding can't automatically be extrapolated to other cTn assays, even less for cTn assays that do not meet criteria for "high-sensitivity" [14]. As the majority of institutions world-wide use sensitive, but not hs-cTn assays, we performed a multicenter study to derive and validate 1 h-and 2 h-algorithms for rule-out and rule-in of AMI using a thoroughlyexamined and commonly used sensitive cTnI assay [8,10,[12][13][14][15][16][17][18][19][20][21][22][23].…”

Management of acute chest pain: A major role for coronary CT angiography

“…These assays provide precise and early evaluation of variations in troponin during ACS. The negative predictive value (NPV) of a single test at admission with these new troponin assays (with a threshold value of 14 pg/ml) has been shown to be above 95% [18][19][20]. Only patients presenting extremely early escape detection, but by performing a second test after three hours the sensitivity is nearly 100% [21][22][23].…”

“…Only patients presenting extremely early escape detection, but by performing a second test after three hours the sensitivity is nearly 100% [21][22][23]. A test result that is elevated and above 50 pg/ml for the initial test and/or that doubles between the first and second test three hours later, is a sign of ACS [20]. Thus reducing the delay between the two tests from 6 to 3 hours with ultrasensitive troponin (Tn US) provides faster assessment of patients.…”