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Canadian Journal of Cardiology

Identifying Very-Low-Risk Patients for Future Myocardial Infarction or Death

Open AccessPublished:October 15, 2022DOI:https://doi.org/10.1016/j.cjca.2022.10.014
      High-sensitivity cardiac troponin (hs-cTn) testing has enabled shorter time intervals between serial measurements when assessing patients with possible acute coronary syndrome (ACS) with the use of a single sample strategy proposed for early risk stratification. Specifically, a rapid rule-out for myocardial infarction (MI) is suitable for a pathway if the sensitivity for 30-day cardiac events is ≥ 99%. At the population level (n = 131,095 emergency department [ED] patients), low hs-cTn results alone yielded sensitivities < 99%. Test performance was improved with additional laboratory tests, with the combination of glucose, estimated glomerular filtration rate (eGFR), and hs-cTnT or hs-cTnI yielding sensitivities > 99.0% in patients ≥ 65 years of age.
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