{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T13:31:13Z","timestamp":1784035873720,"version":"3.55.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,10,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">We implemented a hs\u2010cTnI (high\u2010sensitivity cardiac troponin I)\u2010based algorithm for emergency department (ED) evaluation of possible non\u2010ST\u2013segment\u2010elevation acute coronary syndrome within an integrated health system (Kaiser Permanente Northern California).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">Retrospective study of adult (18+ years) ED encounters for chest pain\/discomfort with hs\u2010cTnI testing (Access hsTnI, Beckman) at 21 medical centers between January 1, 2023 and June 30, 2024, excluding ST\u2013segment\u2010elevation myocardial infarction. The primary outcome was 30\u2010day myocardial infarction or death. Sensitivity, specificity, negative predictive value, positive predictive value, and likelihood ratios were reported, with subgroup analyses by age, sex, coronary artery disease, chronic kidney disease, and ED disposition.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">There were 104\u2009025 encounters in the final cohort (median age 59\u2009years, 45% male, 18% coronary artery disease, and 13% chronic kidney disease). The primary outcome occurred in 5.5% encounters. Rule\u2010out criteria were present in 70% of encounters (sensitivity, 95.4% [95% CI, 94.8%\u201396.0%]; negative predictive value, 99.7% [95% CI, 99.6%\u201399.7%]; likelihood ratio, \u22120.05) and 7% of encounters met rule\u2010in criteria (specificity, 96.7% [95% CI, 96.6\u201396.8%]; positive predictive value, 60.2% [95% CI, 59.3%\u201361.1%]; likelihood ratio, +24.4). In subgroup analyses, rule\u2010out criteria negative predictive value was below 99% in stage 4+ chronic kidney disease (96.1% [95% CI, 94.6%\u201397.6%]) and ischemic coronary artery disease (98.6% [95% CI 98.3\u201398.9%]), though not among those selected for ED discharge (98.4% [95% CI, 96.7%\u201399.2%] and 99.1% [95% CI, 98.8%\u201399.4%], respectively).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">The Kaiser Permanente Northern California non\u2010ST\u2013elevation acute coronary syndrome evaluation algorithm demonstrated excellent overall performance. Negative predictive value was modestly diminished in ischemic coronary artery disease or advanced chronic kidney disease, but risk was largely mitigated by ED discharge disposition decisions.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.125.043756","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T10:33:12Z","timestamp":1759228392000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Validation of a 0\u2010\/2\u2010Hour High\u2010Sensitivity Cardiac Troponin Algorithm for Suspected Acute Coronary Syndrome in the Emergency Department"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5001-7228","authenticated-orcid":false,"given":"Dustin G.","family":"Mark","sequence":"first","affiliation":[{"name":"Kaiser Permanente Northern California","place":["Pleasanton, USA"]},{"name":"Kaiser Permanente","place":["Oakland, USA"]},{"name":"Kaiser 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USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5801-8794","authenticated-orcid":false,"given":"Dustin W.","family":"Ballard","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California","place":["Pleasanton, USA"]},{"name":"Kaiser Permanente","place":["San Rafael, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6559-1858","authenticated-orcid":false,"given":"David R.","family":"Vinson","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California","place":["Pleasanton, USA"]},{"name":"Kaiser Permanente","place":["Roseville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"Reed","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California","place":["Pleasanton, 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