In Search of the 1-Hour Rule-Out for Acute Myocardial Infarction
Benjamin M Scirica1, David A Morrow2
1TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Insights
Serial high-sensitivity cardiac troponin testing offers a reliable method for the rapid rule-out of acute coronary syndrome (ACS). Current protocols may be refined for optimal timing and thresholds, but dual-marker strategies offer no added benefit.
Area of Science:
- Cardiology
- Clinical Diagnostics
- Biomarker Research
Background:
- Established protocols for ruling out acute coronary syndrome (ACS) are being re-evaluated.
- The efficiency and accuracy of current diagnostic approaches are under scrutiny.
Abstract:
Old habits die hard. The study by Hillinger et al. provides a framework for several observations regarding the current state of ADPs for rapid rule-out of ACS. ADPs that incorporate serial assessments of high-sensitivity cardiac troponin appear to provide a viable approach to rule out ACS with sampling over 3 h with a high NPV. The actual interval (1, 2, or 3 h) and optimal thresholds are issues still to be refined for each assay. A dual-marker strategy using copeptin does not provide incremental clinical information beyond high-sensitivity cardiac troponin, and it seems unlikely that other biomarkers will substantially improve the NPV achieved with serial high-sensitivity cardiac troponin testing alone.
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