A novel troponin I rule-out value below the upper reference limit for acute myocardial infarction

摘要: Objective To determine cut-off values for a recently introduced high sensitive cardiac troponin assay (hs-cTnI) which provide similar sensitivity, specificity, negative predictive value (NPV) and positive (PPV) acute myocardial infarction (AMI) as known an hs-cTnT assay. Methods A prospective observational study was performed. Hs-cTnT (Roche) hs-cTnI (Abbott) were measured in consecutive patients with symptoms suggestive of AMI. Representative measurements (obtained at least 3 h after chest pain has started) serial time delay between 2.5 h 4.5 h used to levels. Two independent clinicians adjudicated the final diagnosis. Results 1490 included whom 114 (8%) received diagnosis Receiver operating characteristics analysis showed no statistically significant differences areas under curve two assays. Cut-off representative hs-TnI found be follows: rule-out: 10 ng/L (sensitivity: 98.2%; 95% CI 95.7% 100.0% NPV: 99.8%; 99.5% 100.0%); rule-in: 70 ng/L (specificity: 90.8%; 89.3% 92.4% PPV: 39.7%; 36.1% 43.3%). For we Δ rule-out 20 ng/L 94.9%; 88.0% 98.7%; 96.9% 100.0%) rule-in 100 ng/L 92.7%; 87.9% 95.8% 57.6%; 39.4% 74.0%) 300% 93.8%; 90.4% 97.2% 61.3%; 51.1% 71.5%). Conclusions are determined allow diagnostic classification compared hs-cTnT. Importantly, paradigm this is unmistakably lower than upper reference limit.