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Single High-Sensitivity Cardiac Troponin I to Rule Out Acute Myocardial Infarction

Yader Sandoval1, Stephen W Smith2, Sara A Love3

  • 1Division of Cardiology, Hennepin County Medical Center and Minneapolis Heart Institute, Abbott Northwestern Hospital, Minn.

The American Journal of Medicine
|March 28, 2017
PubMed

Insights

Single high-sensitivity cardiac troponin I (hs-cTnI) measurements effectively rule out acute myocardial infarction. These strategies identify patients with a very low risk of adverse events within 30 days.

Area of Science:

  • Cardiology
  • Biomarkers
  • Emergency Medicine

Background:

  • Acute myocardial infarction (AMI) diagnosis relies on sensitive biomarkers.
  • High-sensitivity cardiac troponin I (hs-cTnI) assays offer improved diagnostic performance.
  • Evaluating single hs-cTnI measurement strategies is crucial for efficient emergency department workflows.

Purpose of the Study:

  • To assess the performance of single hs-cTnI measurement strategies for ruling out AMI.
  • To determine the negative predictive value (NPV) and sensitivity of hs-cTnI for Type 1 and Type 2 AMI.
  • To evaluate the safety outcome (AMI or cardiac death at 30 days) associated with hs-cTnI thresholds.

Main Methods:

  • Prospective, observational study of 1631 emergency department patients.
  • Utilized an investigational hs-cTnI assay for serial measurements.
  • Analyzed hs-cTnI levels below the limit of detection (<1.9 ng/L) and a 5 ng/L threshold, with and without normal ECG.

Main Results:

  • hs-cTnI < Limit of Detection (LoD) showed 99.6% NPV and 98.8% sensitivity for AMI.
  • hs-cTnI < 5 ng/L demonstrated 98.9% NPV and 94.7% sensitivity for AMI.
  • Combining hs-cTnI thresholds with normal ECG yielded high NPV and sensitivity for both AMI and safety outcomes.

Conclusions:

  • Single hs-cTnI measurements, alone or with normal ECG, can rapidly identify low-risk patients for AMI.
  • These strategies facilitate early identification of patients unlikely to experience adverse cardiac events.
  • The findings support the use of hs-cTnI in streamlined protocols for ruling out AMI.
Abstract

Keywords:
Acute myocardial infarctionHigh-sensitivity cardiac troponinTroponin

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