High-Sensitivity Troponin Assays for Early Rule-Out of Myocardial Infarction

Abstract

Introduction: High-sensitivity cardiac troponin (hs-cTn) assays enable rapid rule-out of non-ST-elevation myocardial infarction (NSTEMI). The 0/1-hour algorithm (ESC) requires validation across different hs-cTn assays and populations.
Methods: Systematic review of 12 prospective cohort studies (n=22,418) evaluating hs-cTnI or hs-cTnT 0/1-hour algorithm. Inclusion: emergency department patients with chest pain, last symptom <6 hours. Reference standard: adjudicated NSTEMI by fourth universal definition. Primary outcome: sensitivity and negative predictive value (NPV) for NSTEMI at 30 days.
Results: Pooled sensitivity was 97.1% (95% CI 95.6–98.2%) and NPV 99.4% (98.9–99.7%) using hs-cTnI (Abbott, Siemens). hs-cTnT (Roche) had sensitivity 96.2% and NPV 99.1%. False-negative rate was 0.6% (0.3–0.9%), mostly very early presenters (<2 hours) or small subendocardial infarcts. Specificity was lower (82%) leading to 18% further testing.
Discussion: The 0/1-hour algorithm safely rules out NSTEMI in 60% of patients, reducing observation stays. Assay-specific cutoffs are critical.
Conclusion: High-sensitivity troponin 0/1-hour algorithm has excellent NPV for NSTEMI rule-out but requires assay-specific validation.