• Bernadette Meller, Louise Cullen, William A Parsonage, Jaimi H Greenslade, Sally Aldous, Tobias Reichlin, Karin Wildi, Raphael Twerenbold, Cedric Jaeger, Petra Hillinger, Philip Haaf, Christian Puelacher, Vera Kern, Katharina Rentsch, Fabio Stallone, Maria Rubini Gimenez, Paola Ballarino, Stefano Bassetti, Astrid Walukiewicz, Richard Troughton, Christopher J Pemberton, A Mark Richards, Kevin Chu, Christopher M Reid, Martin Than, and Christian Mueller.
• Department of Cardiology, University Hospital, Basel, Switzerland.
• Int. J. Cardiol. 2015 Apr 1;184:208-15.

BackgroundWe aimed to evaluate the efficacy and safety of using high-sensitivity cardiac troponin T (hs-cTnT) within an accelerated diagnostic protocol (ADP) in patients presenting with symptoms suggestive of acute myocardial infarction (AMI) for rapid rule-out of AMI.MethodsIn two independent large multicenter studies, levels of hs-cTnT at presentation and at 2 h were combined with the Thrombolysis In Myocardial Infarction (TIMI) risk score and ECG findings. The ADP defined patients with normal levels of hs-cTnT at presentation and 2 h, a TIMI score ≤1, and normal ECG findings as candidates for rapid rule-out of AMI and rapid discharge. Major adverse cardiac events (MACEs) occurring within 30-days were centrally adjudicated by two independent cardiologists.ResultsIn the derivation cohort, among 1085 consecutive patients 198 patients (18.2%) had a MACE. The ADP classified 374 patients (34.5%) as low-risk. None of these patients had a MACE at 30 days, resulting in a negative predictive value (NPV) of 100% (95% CI, 99.0-100%) and a sensitivity of 100% (95% CI, 98.2%-100%). In the validation cohort, among 1590 consecutive patients 231 patients (14.5%) had a MACE. The ADP classified 641 patients (40.3%) as low-risk. 6 of these patients had a MACE at 30 days, resulting in a NPV of 99.1% (95% CI, 98.0-99.6%) and a sensitivity of 97.4% (95% CI, 94.5-98.8%).ConclusionsThe ADP including hs-cTnT allows early identification 35 to 40% of patients to be at extremely low risk of MACE and therefore ideal candidates for outpatient management.Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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