Key result
A baseline high-sensitivity cardiac troponin I value below 4.0 ng/L effectively ruled out acute myocardial infarction in 40.9% of emergency department patients, yielding a negative predictive value of 100.0%.
Why the study?
The study was designed to determine whether a baseline high sensitivity cardiac troponin I level below the limit of quantitation can rule out acute myocardial infarction in emergency department patients with symptoms suspicious for a cardiac etiology.
Does a baseline hs-cTnI level <4.0 ng/L safely rule out acute myocardial infarction in emergency department patients presenting with suspicious symptoms?
Population
567 patients presenting to the ED with symptoms suspicious for AMI
Comparison
Baseline hs-cTnI below the limit of quantitation (<4.0 ng/L) vs higher values
Design
Single-center observational ED study
Follow-up
30 days
Authors
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Very low hs-cTnI may support early AMI rule-out in ED; leaves open need for prospective validation before practice change.
Observational (n=567)
No
Does a baseline hs-cTnI level <4.0 ng/L safely rule out acute myocardial infarction in emergency department patients presenting with suspicious symptoms?
Effect estimate: NPV 100.0% (95% CI 98.4%-100.0%)
A single baseline hs-cTnI measurement below the limit of quantitation (<4.0 ng/L) can safely and rapidly rule out acute myocardial infarction in approximately 40% of emergency department patients with suspicious symptoms.
Cook et al. (2020) conducted an observational in Symptoms suspicious for acute myocardial infarction (n=567). Baseline high-sensitivity cardiac troponin I <4.0 ng/L vs. Baseline high-sensitivity cardiac troponin I ≥4.0 ng/L was evaluated on Negative predictive value for acute myocardial infarction at 30 days (NPV 100.0%, 95% CI 98.4%-100.0%). A baseline high-sensitivity cardiac troponin I value below 4.0 ng/L effectively ruled out acute myocardial infarction in 40.9% of emergency department patients, yielding a negative predictive value of 100.0%.
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