What does this research mean for the field?

A single assessment of high-sensitivity cardiac troponin I or T with a threshold of <5 ng/L at presentation provides high sensitivity and negative predictive value for rapidly ruling out myocardial infarction in Chinese emergency department patients. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To identify optimal baseline high-sensitivity cardiac troponin I and T thresholds for rapidly ruling out myocardial infarction and identifying low-risk emergency department patients.

September 15, 2026Clinica Chimica Acta

Rapid myocardial infarction rule-out: A single high-sensitivity cardiac troponin I and T threshold strategy for the Chinese emergency department

Q: What are the key findings of this study?

A single high-sensitivity cardiac troponin I or T threshold of <5 ng/L provided ≥99.2% sensitivity and ≥99.4% negative predictive value for ruling out myocardial infarction.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: suspected acute coronary syndrome (ACS) (n=1225). Intervention: High-sensitivity cardiac troponin I and T thresholds (<5 ng/L) vs. clinical hs-cTn assay. Primary outcome: Negative predictive value and sensitivity for ruling out MI.

Q: What question did this study set out to answer?

To identify optimal baseline high-sensitivity cardiac troponin I and T thresholds for rapidly ruling out myocardial infarction and identifying low-risk emergency department patients.

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Key result

Single hs-cTn threshold below 5 ng/L safely rules out MI with near-perfect NPV.

n=1,225

Why the study?

High-sensitivity cardiac troponin discerns MI with high sensitivity, but its application and optimal hs-cTnI and hs-cTnT thresholds for low-risk patient identification in Chinese emergency departments are understudied.

Does a single high-sensitivity cardiac troponin I and T threshold of <5 ng/L safely and rapidly rule out myocardial infarction in Chinese emergency department patients with suspected ACS?

Population

1225 ED patients suspected of having ACS without STEMI

Comparison

Optimal hs-cTnI and hs-cTnT thresholds vs clinical hs-cTn assay

Design

Prospective observational cohort study

Follow-up

30-day

Authors

YFYang FangfangChinese Academy of Medical Sciences & Peking Union Medical College LLinYahuiChinese Academy of Medical Sciences & Peking Union Medical College ZHZhan HongSun Yat-sen University

Discussion

Member takes

Implication

May support hs-cTn <5 ng/L for MI rule-out in Chinese ED patients; hypothesis-generating and requires prospective validation before practice change.

Key Points

To identify optimal baseline high-sensitivity cardiac troponin I and T thresholds for rapidly ruling out myocardial infarction and identifying low-risk emergency department patients.
Conducted a prospective observational cohort study of N=1225 emergency department patients with suspected acute coronary syndrome, excluding those with ST-segment elevation myocardial infarction.
Measured plasma high-sensitivity cardiac troponin I (hs-cTnI) and troponin T (hs-cTnT) at initial presentation and evaluated negative predictive values for myocardial infarction and 30-day adverse events.
Confirmed myocardial infarction in 365 of 1225 patients (29.8%).
A baseline hs-cTnI concentration of <5 ng/L yielded a sensitivity of 99.2% and a negative predictive value of 99.4%, classifying 42.53% of patients as low risk.
A baseline hs-cTnT concentration of <5 ng/L achieved a sensitivity of 100% and a negative predictive value of 100%, classifying 12.98% of patients as low risk.

Study Design

Type

Cohort (n=1,225)

Multicenter

Yes

Structured PICO

Does a single high-sensitivity cardiac troponin I and T threshold of <5 ng/L safely and rapidly rule out myocardial infarction in Chinese emergency department patients with suspected ACS?

Population

1,225 emergency department patients suspected of having acute coronary syndrome (excluding STEMI) evaluated for 30-day adverse events.

Exposure

Single assessment of plasma high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) at presentation using a unified <5 ng/L threshold.

Comparator

Standard clinical hs-cTn assay and sex-specific rule-out thresholds (hs-cTnI <6 ng/L, hs-cTnT <8 ng/L).

Outcome

Sensitivity and negative predictive value (NPV) for ruling out myocardial infarction (MI).

A single hs-cTnI or hs-cTnT threshold of <5 ng/L at presentation provides excellent sensitivity and negative predictive value for rapidly ruling out MI in Chinese ED patients with suspected ACS.

Cite This Study

Fangfang et al. (2026) conducted a cohort in suspected acute coronary syndrome (ACS) (n=1,225). High-sensitivity cardiac troponin I and T thresholds (<5 ng/L) vs. clinical hs-cTn assay was evaluated on Negative predictive value and sensitivity for ruling out MI. A single high-sensitivity cardiac troponin I or T threshold of <5 ng/L provided ≥99.2% sensitivity and ≥99.4% negative predictive value for ruling out myocardial infarction.

synapsesocial.com/papers/6aa94ffe9013453be30a26cc https://doi.org/10.1016/j.cca.2026.121333

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Implication

May support hs-cTn <5 ng/L for MI rule-out in Chinese ED patients; hypothesis-generating and requires prospective validation before practice change.

Rapid myocardial infarction rule-out: A single high-sensitivity cardiac troponin I and T threshold strategy for the Chinese emergency department

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Rapid myocardial infarction rule-out: A single high-sensitivity cardiac troponin I and T threshold strategy for the Chinese emergency department

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Also Consider