Rapid Rule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement Below the Limit of Detection

Abstract

Emergency Care Foundation.

Clinical chemistry score versus high-sensitivity cardiac troponin I and T tests alone to identify patients at low or high risk for myocardial infarction or death at presentation to the emergency department

“…For identifying low-risk patients who may be suitable for discharge, many different approaches have been proposed, with the simplest being a low or undetectable hs-cTn concentration. 2,3 Despite the ease of these approaches, using hs-cTn alone has not reliably achieved a sensitivity greater than 99.0% to safely rule out MI and discharge patients presenting to the emergency department in large populations. 2,3 At the other extreme, for rule in of MI and identifying patients at high risk who require hospital admission, besides the use of electrocardiograms, algorithms that have used hs-cTn tests alone use cut-offs that are several-fold higher than the published 99th percentiles.…”

“…2,3 Despite the ease of these approaches, using hs-cTn alone has not reliably achieved a sensitivity greater than 99.0% to safely rule out MI and discharge patients presenting to the emergency department in large populations. 2,3 At the other extreme, for rule in of MI and identifying patients at high risk who require hospital admission, besides the use of electrocardiograms, algorithms that have used hs-cTn tests alone use cut-offs that are several-fold higher than the published 99th percentiles. 35 The required specificity or PPV for algorithms to identify patients at high risk have not undergone the same methodological approach as the sensitivity estimate.…”

The Introduction and Clinical Use of Cardiac‐Specific Troponin Assays

“…Importantly, cardiac troponin values less than the LoD with the new assays can be used to effectively exclude myocardial damage in patients presenting within 1 h from the onset of chest pain. 5 …”

Continuous detection of glucose and insulin in live animals

“…Early efforts toward this end have already had a considerable impact; for example, continuous glucose monitors have significantly reduced the burden for diabetes patients and increased the time where patients' blood glucose levels are within the euglycemic range 2 . Similar monitoring could prove invaluable for managing a host of other disease states [3][4][5][6] . Unfortunately, it remains exceedingly difficult to achieve continuous in vivo detection of biomolecules, and to date, continuous real-time sensors have been limited only to a handful of analytes such as glucose 7 , lactate 8 , and blood oxygen 9 .…”