Canadian Journal of Cardiology

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

Open AccessPublished:October 15, 2022DOI:
      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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        • Gulati M.
        • Levy P.D.
        • Mukherjee D.
        • et al.
        2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
        Circulation. 2021; 144: e368-e454
        • Neumann J.T.
        • Twerenbold R.
        • Ojeda F.
        • et al.
        Application of high-sensitivity troponin in suspected myocardial infarction.
        N Engl J Med. 2019; 380: 2529-2540
        • Lau G.
        • Koh M.
        • Kavsak P.A.
        • et al.
        Clinical outcomes for chest pain patients discharged home from emergency departments using high-sensitivity vs conventional cardiac troponin assays.
        Am Heart J. 2020; 221: 84-94
        • Kavsak P.A.
        • Cerasuolo J.O.
        • Ko D.T.
        • et al.
        Using the clinical chemistry score in the emergency department to detect adverse cardiac events: a diagnostic accuracy study.
        CMAJ Open. 2020; 8: E676-E684
        • Westwood M.E.
        • Armstrong N.
        • Worthy G.
        • et al.
        Optimising the use of high-sensitivity troponin assays for the early rule-out of myocardial infarction in patients presenting with chest pain: a systematic review.
        Clin Chem. 2021; 67: 237-244