• Sophie Druey, Karin Wildi, Raphael Twerenbold, Cédric Jaeger, Tobias Reichlin, Philip Haaf, Maria Rubini Gimenez, Christian Puelacher, Max Wagener, Milos Radosavac, Ursina Honegger, Carmela Schumacher, Valentina Delfine, Philip Kreutzinger, Thomas Herrmann, Moreno WeidmannZoraidaZDepartment of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland., Lian Krivoshei, Michael Freese, Claudia Stelzig, Cyril Isenschmid, Stefano Bassetti, Katharina Rentsch, Stefan Osswald, and Christian Mueller.
• Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland; Department of Internal Medicine, Kantonsspital Olten, Switzerland.
• Int. J. Cardiol. 2015 Sep 15; 195: 163-70.

BackgroundIt is currently unknown, whether and to what extent sensitive cardiac troponin (s-cTn) allows shortening of the time required for safe rule-out and rule-in of acute myocardial infarction (AMI).MethodsWe aimed to develop and validate early rule-out and rule-in algorithms for AMI using a thoroughly-examined and commonly used s-cTnI assay in a prospective multicenter study including 2173 patients presenting to the emergency department with suspected AMI. S-cTnI was measured in a blinded fashion at 0 h, 1 h, and 2 h. The final diagnosis was centrally adjudicated by two independent cardiologists. In the derivation cohort (n = 1496), we developed 1h- and 2h-algorithms assigning patients to "rule-out", "rule-in", or "observe". The algorithms were then prospectively validated in the validation cohort (n = 677).ResultsAMI was the adjudicated diagnosis in 17% of patients. After applying the s-cTnI 1h-algorithm developed in the derivation cohort to the validation cohort, 65% of patients were classified as "rule-out", 12% as "rule-in", and 23% to "observe". The negative predictive value for AMI in the "rule-out" group was 98.6% (95% CI, 96.9-99.5), the positive predictive value for AMI in the "rule-in" group 76.3% (95% CI, 65.4-85.1). Overall, 30-day mortality was 0.2% in the "rule-out" group, 1.0% in the "observe" group, and 3.0% in the "rule-in" group. Similar results were obtained for the 2h-algorithm.ConclusionWhen used in conjunction with other clinical information including the ECG, a simple algorithm incorporating s-cTnI values at presentation and after 1h (or 2h) will allow safe rule-out and accurate rule-in of AMI in the majority of patients.Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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