{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T20:15:11Z","timestamp":1790712911196,"version":"4.1.0"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2022,6,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>There are good data to support using a single high-sensitivity cardiac troponin T (hs-cTnT) below the limit of detection of 5 ng\/L to exclude acute myocardial infarction. Per the US Food and Drug Administration, hs-cTnT can only report to the limit of quantitation of 6 ng\/L, a threshold for which there are limited data. Our goal was to determine whether a single hs-cTnT below the limit of quantitation of 6 ng\/L is a safe strategy to identify patients at low risk for acute myocardial injury and infarction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The efficacy (proportion identified as low risk based on baseline hs-cTnT&lt;6 ng\/L) of identifying low-risk patients was examined in a multicenter (n=22 sites) US cohort study of emergency department patients undergoing at least 1 hs-cTnT (CV Data Mart Biomarker cohort). We then determined the performance of a single hs-cTnT&lt;6 ng\/L (biomarker alone) to exclude acute myocardial injury (subsequent hs-cTnT &gt;99th percentile in those with an initial hs-cTnT&lt;6 ng\/L). The clinically intended rule-out strategy combining a nonischemic ECG with a baseline hs-cTnT&lt;6 ng\/L was subsequently tested in an adjudicated cohort in which the diagnostic performance for ruling out acute myocardial infarction and safety (myocardial infarction or death at 30 days) were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 85\u2009610 patients were evaluated in the CV Data Mart Biomarker cohort, among which 24\u2009646 (29%) had a baseline hs-cTnT&lt;6 ng\/L. Women were more likely than men to have hs-cTnT&lt;6 ng\/L (38% versus 20%,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001). Among 11\u2009962 patients with baseline hs-cTnT&lt;6 ng\/L and serial measurements, only 1.2% developed acute myocardial injury, resulting in a negative predictive value of 98.8% (95% CI, 98.6\u201399.0) and sensitivity of 99.6% (95% CI, 99.5\u201399.6). In the adjudicated cohort, a nonischemic ECG with hs-cTnT&lt;6 ng\/L identified 33% of patients (610\/1849) as low risk and resulted in a negative predictive value and sensitivity of 100% and a 30-day rate of 0.2% for myocardial infarction or death.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A single hs-cTnT below the limit of quantitation of 6 ng\/L is a safe and rapid method to identify a substantial number of patients at very low risk for acute myocardial injury and infarction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.122.059235","type":"journal-article","created":{"date-parts":[[2022,5,10]],"date-time":"2022-05-10T05:01:48Z","timestamp":1652158908000},"page":"1708-1719","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":51,"title":["Rapid Exclusion of Acute Myocardial Injury and Infarction With a Single High-Sensitivity Cardiac Troponin T in the Emergency Department: A Multicenter United States Evaluation"],"prefix":"10.1161","volume":"145","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4800-2972","authenticated-orcid":true,"given":"Yader","family":"Sandoval","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Diseases (Y.L., L.D.M., R.L., R.G., A.S.J.), Mayo Clinic, Rochester, MN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7934-8741","authenticated-orcid":true,"given":"Bradley R.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Division of Biomedical Statistics and Informatics (B.R.L.), Mayo Clinic, Rochester, MN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramila A.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Research (R.A.M.), Mayo College of Medicine, Rochester, MN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5230-7037","authenticated-orcid":true,"given":"Olatunde","family":"Ola","sequence":"additional","affiliation":[{"name":"Division of Hospital Internal Medicine (O.O., A.A., S.K..), Mayo Clinic Health System, La Crosse, WI."},{"name":"Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester MN (O.O., A.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D.","family":"Knott","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine (J.D.K.), Mayo Clinic, Rochester, MN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0574-4052","authenticated-orcid":true,"given":"Laura","family":"De Michieli","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases (Y.L., L.D.M., R.L., R.G., A.S.J.), Mayo Clinic, Rochester, MN."},{"name":"Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy (L.D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok","family":"Akula","sequence":"additional","affiliation":[{"name":"Division of Hospital Internal Medicine (O.O., A.A., S.K..), Mayo Clinic Health System, La Crosse, WI."},{"name":"Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester MN (O.O., A.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronstan","family":"Lobo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases (Y.L., L.D.M., R.L., R.G., A.S.J.), Mayo Clinic, Rochester, MN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric H.","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ (E.H.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Michael","family":"Gharacholou","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (S.M.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6847-2416","authenticated-orcid":true,"given":"Marshall","family":"Dworak","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases (M.D., N.R., T.T., C.C.), Mayo Clinic Health System, La Crosse, WI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Crockford","sequence":"additional","affiliation":[{"name":"Department of Family Medicine (E.C.), Mayo Clinic Health System, La Crosse, WI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Rastas","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases (M.D., N.R., T.T., C.C.), Mayo Clinic Health System, La Crosse, WI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Grube","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (E.G.), Mayo Clinic Health System, La Crosse, WI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swetha","family":"Karturi","sequence":"additional","affiliation":[{"name":"Division of Hospital Internal Medicine (O.O., A.A., S.K..), Mayo Clinic Health System, La Crosse, WI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Wohlrab","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology (S.W.), Mayo Clinic Health System, La Crosse, WI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5148-9174","authenticated-orcid":true,"given":"David O.","family":"Hodge","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Research, Mayo College of Medicine, Jacksonville, FL (D.O.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahir","family":"Tak","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases (M.D., N.R., T.T., C.C.), Mayo Clinic Health System, La Crosse, WI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Cagin","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases (M.D., N.R., T.T., C.C.), Mayo Clinic Health System, La Crosse, WI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2713-0433","authenticated-orcid":true,"given":"Rajiv","family":"Gulati","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases (Y.L., L.D.M., R.L., R.G., A.S.J.), Mayo Clinic, Rochester, MN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1183-3959","authenticated-orcid":true,"given":"Allan S.","family":"Jaffe","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases (Y.L., L.D.M., R.L., R.G., A.S.J.), Mayo Clinic, Rochester, MN."},{"name":"Department of Laboratory Medicine and Pathology (A.S.J.), Mayo Clinic, Rochester, MN."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001030"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2016.255109"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2015.12.005"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2562"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.17488"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.7326\/M21-1499"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00391-8"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.05.058"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2017.02.032"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.052380"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2020-316692"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.042891"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2021-001769"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv320"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa575"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/hvaa264"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2017.07.033"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2017.4625"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.049298"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.12.036"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.07.746"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13229"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j4788"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.5830"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqab082"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cca.2010.12.034"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.033861"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2021.02.021"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/HPC.0000000000000164"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000617"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.06.026"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2016.264523"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.37930"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.0716"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2016.263764"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.04.050"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.036528"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2018.07.045"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2012.09.171"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2009.132654"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cca.2010.12.034"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/hvz029"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.045480"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/26.4.404"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-308917"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2017.285700"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.122.059235","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T04:09:13Z","timestamp":1715573353000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.122.059235"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,7]]},"references-count":46,"journal-issue":{"issue":"23","published-print":{"date-parts":[[2022,6,7]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.122.059235"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.122.059235","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,7]]},"assertion":[{"value":"2022-01-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-04-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}