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Evaluating Rapid Rule-out of Acute Myocardial Infarction Using a High-Sensitivity Cardiac Troponin I Assay at

Jaimi Greenslade1,2, Elizabeth Cho2, Christopher Van Hise2

  • 1Royal Brisbane and Women's Hospital, Herston, Australia; j.greenslade@uq.edu.au.

Clinical Chemistry
|February 9, 2018
PubMed

Insights

A single cardiac troponin I (cTnI) test below 2 ng/L can safely rule out acute myocardial infarction (AMI) in most emergency department patients. This high-sensitivity assay improves diagnostic efficiency and reduces unnecessary assessments.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Clinical Diagnostics

Background:

  • Low cardiac troponin (cTn) concentrations are used for rapid rule-out of acute myocardial infarction (AMI).
  • The Beckman Coulter Access high-sensitivity cardiac troponin I (hs-cTnI) assay requires evaluation for a single test threshold for safe AMI rule-out.

Purpose of the Study:

  • To identify a single test threshold using the Beckman Coulter Access hs-cTnI assay for the safe rule-out of acute myocardial infarction (AMI).

Main Methods:

  • Analysis of stored samples from 1871 patients presenting with acute coronary syndrome symptoms.
  • Measurement of hs-cTnI on presentation and calculation of sensitivity and negative predictive value (NPV) for type 1 myocardial infarction (T1MI).

Main Results:

  • A hs-cTnI cutoff <2 ng/L demonstrated 99.0% sensitivity and 99.8% NPV for T1MI.
  • A cutoff <6 ng/L achieved 99.5% NPV but missed more AMI cases (93.9% sensitivity).

Conclusions:

  • A single baseline hs-cTnI <2 ng/L with the Access assay effectively rules out AMI in 99% of patients.
  • This threshold can reduce lengthy patient assessments, while a <6 ng/L cutoff is less suitable due to missed AMI cases.
Abstract

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