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Abstract / Description of output
Methods: In patients with possible myocardial infarction, the diagnostic performance of a single measurement of high-sensitivity cardiac troponin I at presentation was evaluated and externally validated in those tested ≤3, 4-12 and >12 hours from symptom onset. The limit of detection (2 ng/L), rule-out (5 ng/L) and sex-specific 99th centile (16 ng/L women, 34 ng/L men) thresholds were compared.
Results: In 41,103 consecutive patients (60  years, 46% women), 12,595 (31%) presented within 3 hours and 3,728 (9%) had myocardial infarction. In those presenting ≤3 hours, a threshold of 2 ng/L had greater sensitivity and negative predictive value (99.4% [95% confidence interval 99.2-99.5%] and 99.7% [99.6-99.8%]) compared to 5 ng/L (96.5% [96.2-96.8%] and 99.3% [99.1- 99.4%]). In those presenting ≥3 hours, the sensitivity and negative predictive value were similar for both thresholds. The sensitivity of the 99th centile was low in early and late presenters at 71.4% [70.6-72.2%] and 92.5% [92.0-93.0%], respectively. Findings were consistent in an external validation cohort of 7,088 patients.
Conclusions: In early presenters, a single measurement of high-sensitivity cardiac troponin I below the limit of detection may facilitate the safe rule out of myocardial infarction. The 99th centile should not be used to rule out myocardial infarction at presentation even in those presenting later following symptom onset.
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1/08/21 → 31/07/23
Takeshi Fujisawa (Manager)Deanery of Clinical Sciences