Coronary disease & ACSDiagnostic or prognostic study
Troponin in early presenters to rule out myocardial infarction
- Diagnostic accuracy study
- external validation
- 12 595 (31%) presented within 3 h; 3728 (9%) had MI
Authors' conclusion
In early presenters, a single measurement of high-sensitivity cardiac troponin I below the limit of detection may facilitate the safe rule out of myocardial infarction.
Study context
- Population
- Consecutive patients with possible MI, by time from symptom onset (≤3, 4–12, >12 h)external validation n = 7088
- Participants
- 41,103 patients
- Comparison
- 2 ng/L vs 5 ng/L vs 99th centile
- Outcome
- Diagnostic performance (sensitivity, NPV) of a single hs-cTnI measurement for ruling out MI
- Follow-up
- At presentation
Performance
As reported in the abstract
Rule-out of MI, presenting ≤3 h
| Test or model | Sensitivity | NPV |
|---|---|---|
| 2 ng/L | 99.4% (95% CI 99.2%-99.5%) | 99.7% (99.6%-99.8%) |
| 5 ng/L | 96.5% (96.2%-96.8%) | 99.3% (99.1%-99.4%) |
Further findings
- Sensitivity of 99th centile
- 71.4% (70.6%-72.2%) · Sensitivity, early presenters · Sensitivity, late presenters 92.5% (92.0%-93.0%)
Rule-out of MI, presenting ≥3 h
- Sensitivity and NPV similar for 2 ng/L and 5 ng/L
External validation
- Findings consistent in external validation cohort
- 7088
Original publication
Troponin in early presenters to rule out myocardial infarction. Eur Heart J. Published 23 June 2023. doi:10.1093/eurheartj/ehad376
Summarised from the published abstract; every number is checked against it