What does this research mean for the field?

High-sensitivity cardiac troponin assays demonstrate excellent diagnostic accuracy for early acute myocardial infarction detection in emergency department patients, with high sensitivity (≥96%) and negative predictive value (≥99%) enabling safe rule-out. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 5, 2026The Review of Diabetic StudiesOpen Access

Diagnostic Accuracy Of High-Sensitivity Cardiac Troponin For The Early Detection Of Acute Myocardial Infarction In Emergency Department Patients: A Systematic Review

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Suspected acute myocardial infarction. Intervention: High-sensitivity cardiac troponin (hs-cTn) assays vs. Conventional troponin assays or alternative diagnostic algorithms. Primary outcome: Diagnostic accuracy (AUC, sensitivity, specificity, NPV, PPV) (AUC 0.84 to 0.98).

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Key result

hs-cTn assays show excellent early AMI detection with negative predictive value ≥99%.

AUC 0.84 to 0.98

Why the study?

High-sensitivity cardiac troponin assays have transformed early AMI diagnosis in ED patients, but their diagnostic accuracy and rapid algorithm performance require systematic evaluation.

Do high-sensitivity cardiac troponin assays provide accurate diagnostic performance for the early detection of acute myocardial infarction in emergency department patients?

Comparison

High-sensitivity cardiac troponin assays and rapid diagnostic algorithms

Design

Systematic review of prospective, retrospective, and multicenter diagnostic accuracy studies

Authors

MAMoamen Abdelfadil Ismail, Reef Turki Alshahrani, Turki Mohammed Alaklabi, Sultan Mofleh S. Albogami, Zyad Abdulaziz A. Alghamdi, Omar Buti Ajab Alshahrani, Naif Ayidh Q Alharthi, Nurah Khalid Aldosari NANourah Ali Alshahrani, Lamyaa Sayaf Almaawai, Aseel Khalid M. Alqahtani, Abeer Adel Alshaer, Saad Mohammed Alharthi, Raghad Mohammed Alajlan, Roa Abdalla Mergani Abdalla

Discussion

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Implication

Supports safe early AMI rule-out in the ED; confirms high diagnostic accuracy of hs-cTn assays and rapid algorithms.

Key Points

To evaluate the diagnostic accuracy of high-sensitivity cardiac troponin assays for early detection of acute myocardial infarction in emergency department patients and assess the performance of rapid diagnostic algorithms.
Systematic search conducted across PubMed, Scopus, Web of Science, Embase, and Google Scholar up to December 2025 following PRISMA 2020 guidelines.
Synthesized findings via narrative synthesis due to methodological heterogeneity and variable outcome definitions, precluding formal meta-analysis.
Assays demonstrated area under the curve values ranging from 0.84 to 0.98, with sensitivity ≥96% and negative predictive value ≥99% supporting safe rule-out of acute myocardial infarction.
Rapid 0/1-hour and 0/2-hour diagnostic algorithms effectively classified 50–66% of emergency department patients as low risk.
Absolute troponin changes yielded superior diagnostic accuracy over relative changes, although positive predictive value and specificity were lower during early presentations.

Study Design

Type

Systematic Review

Structured PICO

Do high-sensitivity cardiac troponin assays provide accurate diagnostic performance for the early detection of acute myocardial infarction in emergency department patients?

Population

Systematic review of 12 studies evaluating adult patients presenting to the emergency department with suspected acute myocardial infarction or acute coronary syndrome.

Exposure

High-sensitivity cardiac troponin assays (hs-cTnT or hs-cTnI), including laboratory-based and point-of-care testing, and rapid diagnostic algorithms (0/1-hour and 0/2-hour).

Comparator

Conventional troponin assays, alternative hs-cTn assays, or different diagnostic algorithms (e.g., absolute vs relative change).

Outcome

Diagnostic accuracy measures including sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and area under the curve (AUC).surrogate

Main Result

Effect estimate: AUC 0.84 to 0.98

High-sensitivity cardiac troponin assays, particularly when integrated into rapid 0/1-hour or 0/2-hour algorithms, provide excellent sensitivity and negative predictive value for the safe and early rule-out of acute myocardial infarction in the emergency department.

Limitations

Heterogeneity in study designs, patient populations, and diagnostic thresholds
Variations in assay types and protocols across studies
Most included studies were conducted in high-resource settings
Potential publication bias
Reliance on secondary data
Heterogeneity in study designs, patient populations, and diagnostic thresholds limited the ability to perform a quantitative meta-analysis
Variations in assay types and protocols across studies may affect comparability
Most included studies were conducted in high-resource settings, limiting generalizability to low-resource environments
Reliance on secondary data dependent on the quality of original studies

Cite This Study

Aldosari et al. (2025) conducted a systematic review in Suspected acute myocardial infarction. High-sensitivity cardiac troponin (hs-cTn) assays vs. Conventional troponin assays or alternative diagnostic algorithms was evaluated on Diagnostic accuracy (AUC, sensitivity, specificity, NPV, PPV) (AUC 0.84 to 0.98). High-sensitivity cardiac troponin assays demonstrated excellent diagnostic performance for early acute myocardial infarction detection, with AUC values ranging from 0.84 to 0.98 and negative predictive values ≥99%.

synapsesocial.com/papers/6ac2fd087180a622ddd4df13 https://doi.org/10.70082/2c7pp707

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Diagnostic Accuracy Of High-Sensitivity Cardiac Troponin For The Early Detection Of Acute Myocardial Infarction In Emergency Department Patients: A Systematic Review

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Diagnostic Accuracy Of High-Sensitivity Cardiac Troponin For The Early Detection Of Acute Myocardial Infarction In Emergency Department Patients: A Systematic Review

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

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