Does an undetectable hs-cTnT level (<5 ng/l) and an ECG without signs of ischemia safely rule out myocardial infarction and death within 30 days in patients presenting to the emergency department with chest pain?
Patients presenting to the emergency department with chest pain who have an undetectable hs-cTnT level and a non-ischemic ECG have a near 100% negative predictive value for 30-day MI or death, allowing for safe early discharge.
OBJECTIVES: This study sought to evaluate if an undetectable (14 ng/l. During 30-day follow-up, 39 (0.44%) patients with undetectable hs-cTnT had a MI, of whom 15 (0.17%) had no ischemic ECG changes. The negative predictive value for MI within 30 days in patients with undetectable hs-cTnT and no ischemic ECG changes was 99.8% (95% confidence interval CI: 99.7 to 99.9). The negative predictive value for death was 100% (95% CI: 99.9 to 100). CONCLUSIONS: All patients with chest pain who have an initial hs-cTnT level of <5 ng/l and no signs of ischemia on an ECG have a minimal risk of MI or death within 30 days, and can be safely discharged directly from the ED.
Bandstein et al. (2014) studied this question.