Coronary disease & ACSDiagnostic or prognostic study
Early Rule Out of Myocardial Infarction With a Novel High-Sensitivity Cardiac Troponin T Assay
- Diagnostic accuracy study
- prospective
- multicentre
- external validation cohort
Authors' conclusion
Results of this cohort study suggest that compared with the fifth-generation hs-cTnT assay, use of the sixth-generation assay with a risk-stratification threshold based on clinical performance could double identification of patients at low risk of myocardial infarction or cardiac death at presentation.
Study context
- Population
- Adults with possible NSTEMI in the ED; derivation Scotland 2022–2025, validation Czechia, Italy, Poland, Spain, Switzerland 2014–2019derivation cohort
- Participants
- 987 adults
- Comparison
- Sixth-generation high-sensitivity cardiac troponin T (hs-cTnT) vs Fifth-generation hs-cTnT
- Outcome
- Type 1, 4b or 4c MI or cardiac death (adjudicated); highest presentation threshold with NPV ≥99.5% and sensitivity ≥99%
- Follow-up
- 30 days
Performance
As reported in the abstract
Sixth-generation hs-cTnT <13 ng/L at presentation
| Test or model | Value | NPV | Sensitivity |
|---|---|---|---|
| Sixth-generation hs-cTnT | 61% | 99.9% (95% CrI, 99.7%-100%) | 99.4% (95% CrI, 97.7%-100%) |
Further findings
Patients identified as low risk at presentation in the early rule-out pathway, sixth- vs fifth-generation assay
- Low risk with sixth-generation assay
- 376 [41.0%]
- Low risk with fifth-generation assay
- 160 [17.4%]
- Sixth- vs fifth-generation assay
- P < 0.001
External validation cohort: hs-cTnT <13 ng/L at presentation (sixth-generation) vs below fifth-generation low risk-stratification threshold
- Sixth-generation hs-cTnT <13 ng/L
- 782 of 1721 (45.4%)
- Sixth-generation NPV
- 99.0% (95% Cr, 98.3%-99.6%)
- Sixth-generation sensitivity
- 97.5% (95% Cr, 95.8%-99.0%)
- Below fifth-generation low risk-stratification threshold
- 118 (6.9%)
- Sixth- vs fifth-generation
- P < 0.001
- CrI
Original publication
Early Rule Out of Myocardial Infarction With a Novel High-Sensitivity Cardiac Troponin T Assay. JAMA Cardiol. Published 1 June 2026. doi:10.1001/jamacardio.2026.0477
Summarised from the published abstract; every number is checked against it