{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T09:32:15Z","timestamp":1775208735181,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2017,8,11]],"date-time":"2017-08-11T00:00:00Z","timestamp":1502409600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["MOP\u2010130316"],"award-info":[{"award-number":["MOP\u2010130316"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2017,10]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>The objective of this study was to quantify the sensitivity of very low concentrations of high\u2010sensitivity cardiac troponin T (hsTnT) at ED<\/jats:styled-content> arrival for acute myocardial infarction (AMI<\/jats:styled-content>) in a large cohort of chest pain patients evaluated in real\u2010world clinical practice.<\/jats:p><\/jats:sec>Methods<\/jats:title>This retrospective study included consecutive ED<\/jats:styled-content> patients with suspected cardiac chest pain evaluated in four urban ED<\/jats:styled-content>s, excluding those with ST<\/jats:styled-content>\u2010elevation AMI<\/jats:styled-content>, cardiac arrest or abnormal kidney function. The primary outcomes were AMI<\/jats:styled-content> at 7, 30, and 90 days. Secondary outcomes included major adverse cardiac events (MACE<\/jats:styled-content>; all\u2010cause mortality, AMI<\/jats:styled-content>, and revascularization) and the individual MACE<\/jats:styled-content> components. Test characteristics were calculated for hsTnT values from 3 to 200\u00a0ng\/L .<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 7,130 patients met inclusion criteria. AMI<\/jats:styled-content> incidences at 7, 30, and 90 days were 5.8, 6.0, and 6.2%. When the hsTnT assay was performed at ED<\/jats:styled-content> arrival, the limit of blank of the assay (3\u00a0ng\/L) ruled out 7\u2010day AMI<\/jats:styled-content> in 15.5% of patients with 100% sensitivity and negative predictive value (NPV<\/jats:styled-content>). The limit of detection of the assay (5\u00a0ng\/L) ruled out AMI<\/jats:styled-content> in 33.6% of patients with 99.8% sensitivity and 99.95% NPV<\/jats:styled-content> for 7\u2010day AMI<\/jats:styled-content>. The limit of quantification (the Food and Drug Administration [FDA<\/jats:styled-content>]\u2010approved cutoff for lower the reportable limit) of 6\u00a0ng\/L ruled out AMI<\/jats:styled-content> in 42.2% of patients with 99.8% sensitivity and 99.95% NPV<\/jats:styled-content>. The sensitivities of the cutoffs of <3, <5, and <6\u00a0ng\/L for 7\u2010day MACE<\/jats:styled-content> were 99.6, 97.4, and 96.6%, respectively. The NPV<\/jats:styled-content>s of the cutoffs of <3, <5, and <6\u00a0ng\/L for 7\u2010day MACE<\/jats:styled-content> were 99.8, 99.5, and 99.4%, respectively. A secondary analysis was performed in a subgroup of 3,549 higher\u2010risk patients who underwent serial troponin testing. In this subgroup, a cutoff of 3\u00a0ng\/L ruled out 7\u2010day AMI<\/jats:styled-content> in 9.6% of patients with 100% sensitivity and NPV<\/jats:styled-content>, a cutoff of 5\u00a0ng\/L ruled out 7\u2010day AMI<\/jats:styled-content> in 23.3% of patients with 99.7% sensitivity and 99.9% NPV<\/jats:styled-content>, and a cutoff of 6\u00a0ng\/L ruled out 7\u2010day AMI<\/jats:styled-content> in 29.8% of patients with 99.7 and 99.9% NPV<\/jats:styled-content>. In the higher\u2010risk subgroup, the sensitivities of cutoffs of <3, <5, and <6\u00a0ng\/L for 7\u2010day MACE<\/jats:styled-content> were 99.8, 97.4, and 96.6%, respectively. In this higher\u2010risk subgroup, the NPV<\/jats:styled-content> of cutoffs of <3, <5, and <6\u00a0ng\/L for 7\u2010day MACE<\/jats:styled-content> were 99.7, 98.5, and 98.4%, respectively.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>When used in real\u2010world clinical practice conditions, hsTnT concentrations\u00a0<\u00a06\u00a0ng\/L (below the lower reportable limit for an FDA<\/jats:styled-content>\u2010approved assay) at the time of ED<\/jats:styled-content> arrival can rule out AMI<\/jats:styled-content> with very high sensitivity and NPV<\/jats:styled-content>. The sensitivity for MACE<\/jats:styled-content> is unacceptably low, and thus a single\u2010troponin rule\u2010out strategy should only be used in the context of a structured risk evaluation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13229","type":"journal-article","created":{"date-parts":[[2017,5,23]],"date-time":"2017-05-23T14:51:24Z","timestamp":1495551084000},"page":"1267-1277","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Undetectable Concentrations of a Food and Drug Administration\u2013approved High\u2010sensitivity Cardiac Troponin T Assay to Rule Out Acute Myocardial Infarction at Emergency Department Arrival"],"prefix":"10.1111","volume":"24","author":[{"given":"Andrew D.","family":"McRae","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine University of Calgary Calgary Alberta"},{"name":"Department of Community Health Sciences University of Calgary Calgary 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Calgary Calgary Alberta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunqi","family":"Ji","sequence":"additional","affiliation":[{"name":"Alberta Health Services Calgary Alberta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shabnam","family":"Vatanpour","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Calgary Calgary Alberta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tasnima","family":"Abedin","sequence":"additional","affiliation":[{"name":"Alberta Health Services Calgary Alberta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences University of Calgary Calgary Alberta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle A.","family":"Southern","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences 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