{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T17:25:19Z","timestamp":1762017919845,"version":"3.44.0"},"reference-count":30,"publisher":"BMJ","issue":"16","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2016,5,16]]},"published-print":{"date-parts":[[2016,8,15]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To validate the National Institute for Health and Care Excellence (NICE) recommended algorithms for high-sensitivity troponin (hsTn) assays in adults presenting with chest pain.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>International post hoc analysis of three prospective, observational studies from tertiary hospital emergency departments. The primary endpoint was cardiac death or acute myocardial infarction (AMI) within 24\u2005hours of presentation, and the secondary endpoint was major adverse cardiac events (MACE) at 30\u2005days.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>15% of patients were diagnosed with non-ST elevation myocardial infarction (MI) on admission. The hsTnI algorithm classified 2506\/3128 (80.1%) of patients as \u2018ruled out\u2019 with 50 (2.0%) missed MI. 943\/3128 (30.1%) of patients had a troponin I level below the limit of detection on admission with 2 (0.2%) missed MI. For the hsTnT algorithm, 1794\/3374 (53.1%) of patients were \u2018ruled out\u2019 with 7 (0.4%) missed MI. 490\/3374 (14.5%) of patients had a troponin T below the limit of blank on admission with no MI. MACE at 30\u2005days occurred in 10.7% and 8.5% of patients \u2018ruled out\u2019 defined by the hsTnI and hsTnT algorithms, respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The NICE algorithms could identify patients with low probability of AMI within 2\u2005hours; however, neither strategy performed as predicted by the NICE diagnostic guidance model. Additionally, the rate of MACE at 30\u2005days was sufficiently high that the algorithms should only be used as one component of a more extensive model of risk stratification.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>ACTRN12611001069943, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT00470587\">NCT00470587<\/jats:ext-link>; post-results.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2016-309270","type":"journal-article","created":{"date-parts":[[2016,6,10]],"date-time":"2016-06-10T22:34:06Z","timestamp":1465598046000},"page":"1279-1286","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Validation of NICE diagnostic guidance for rule out of myocardial infarction using high-sensitivity troponin tests"],"prefix":"10.1136","volume":"102","clinical-trial-number":[{"clinical-trial-number":"nct00470587","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct00470587","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"W A","family":"Parsonage","sequence":"first","affiliation":[{"name":"Royal Brisbane & Women's Hospital, Herston, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C","family":"Mueller","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, University Hospital, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J H","family":"Greenslade","sequence":"additional","affiliation":[{"name":"Royal Brisbane & Women's Hospital, Herston, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K","family":"Wildi","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, University Hospital, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Pickering","sequence":"additional","affiliation":[{"name":"Christchurch Hospital, Christchurch, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Than","sequence":"additional","affiliation":[{"name":"Christchurch Hospital, Christchurch, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Aldous","sequence":"additional","affiliation":[{"name":"Christchurch Hospital, Christchurch, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Boeddinghaus","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, University Hospital, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C J","family":"Hammett","sequence":"additional","affiliation":[{"name":"Royal Brisbane & Women's Hospital, Herston, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Hawkins","sequence":"additional","affiliation":[{"name":"Royal Brisbane & Women's Hospital, Herston, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Nestelberger","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, University Hospital, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Reichlin","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, University Hospital, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Reidt","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, University Hospital, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Rubin Gimenez","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, University Hospital, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J R","family":"Tate","sequence":"additional","affiliation":[{"name":"Royal Brisbane & Women's Hospital, Herston, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R","family":"Twerenbold","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, University Hospital, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J P","family":"Ungerer","sequence":"additional","affiliation":[{"name":"Royal Brisbane & Women's Hospital, Herston, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L","family":"Cullen","sequence":"additional","affiliation":[{"name":"Royal Brisbane & Women's Hospital, Herston, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,6,10]]},"reference":[{"key":"2025092015060612000_102.16.1279.1","unstructured":"Bhuiya F , Pitts SR , McCaig LF . Emergency department visits for chest pain and abdominal pain: United States, 1999\u20132008. NCHS data brief. 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