Key result
Baseline hs-cTnI below 2 ng/L safely rules out 1-year CV death or MI with ~99.9% NPV.
Why the study?
There are limited real-world data on outcomes of patients discharged from ED after a single very low high-sensitivity troponin I test, especially beyond 30 days.
Does a single high-sensitivity troponin I test result below the limit of detection safely rule out acute coronary syndrome in patients presenting to the emergency department?
Population
6633 patients ≥20 years old presenting to four EDs who underwent a single hs-cTnI test and were discharged
Comparison
Single hs-cTnI test result below (<2 ng/L) or close to (<5 ng/L) the limit of detection
Design
Multi-centre cohort study using linked administrative data
Follow-up
30 and 365 days
Authors
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May identify very low-risk emergency department patients; leaves open whether prospective trials confirm safety of expedited discharge.
Cohort (n=6,633)
Yes
Does a single high-sensitivity troponin I test result below the limit of detection safely rule out acute coronary syndrome in patients presenting to the emergency department?
Effect estimate: NPV 99.85% (95% CI 99.72-99.98)
A single high-sensitivity troponin I test result below or close to the limit of detection safely identifies ED patients at very low risk for MI and cardiovascular death, supporting an expedited discharge strategy.
Hickling et al. (2024) conducted a cohort in Suspected acute coronary syndrome (n=6,633). Single high-sensitivity cardiac troponin I test <2 ng/L was evaluated on Composite of cardiovascular death and myocardial infarction at 365 days (NPV 99.85%, 95% CI 99.72-99.98). A single high-sensitivity troponin I test result below 2 ng/L at emergency department presentation yielded a negative predictive value of 99.85% for cardiovascular death and myocardial infarction at 365 days.
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