Single Troponin Measurement to Rule-out Myocardial Infarction

IFCC Committee on Cardiac Bio-Markers, Allan S Jaffe, Rick Body, Nicholas L Mills, Kristin M Aakre, Paul O Collinson, Amy Saenger, Ole Hammarsten, Ryan Wereski, Torbjørn Omland, Yader Sandoval, Jordi Ordonez-Lanos, Fred S Apple

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

The term “single-sample rule-out” refers to the ability of very low concentrations of high-sensitivity cardiac troponin (hs-cTn) on presentation to exclude acute myocardial infarction with high clinical sensitivity and negative predictive value. Observational and randomized studies have confirmed this ability. Some guidelines endorse use of a concentration of hs-cTn at the assay’s limit of detection, while other studies have validated the use of higher concentrations, allowing this approach to identify a greater proportion of patients at low risk. In most studies, at least 30% of patients can be triaged with this approach. The concentration of hs-cTn varies according to the assay used and sometimes how regulations permit reporting. It is clear that patients need to be at least 2 hours from the onset of symptoms being evaluated. Caution is warranted, particularly with older patients, women, and patients with underlying cardiac comorbidities.
Original languageEnglish
JournalJournal of the American College of Cardiology
Early online date26 Jun 2023
Publication statusE-pub ahead of print - 26 Jun 2023


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