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Ann Emerg Med. 2018 Dec;72(6):654-664. doi: 10.1016/j.annemergmed.2018.06.021. Epub 2018 Aug 14.

Ultrarapid Rule-out for Acute Myocardial Infarction Using the Generation 5 Cardiac Troponin T Assay: Results From the REACTION-US Study.

Author information

1
Department of Emergency Medicine, Henry Ford Health System, Detroit, MI. Electronic address: rnowak1@hfhs.org.
2
Department of Internal Medicine, Henry Ford Health System, Detroit, MI.
3
Department of Public Health Sciences, Henry Ford Health System, Detroit, MI.
4
Department of Pathology, University of Maryland School of Medicine, Baltimore, MD.
5
Department of Emergency Medicine, Henry Ford Health System, Detroit, MI.
6
Henry Ford Heart and Vascular Institute, Henry Ford Health System, Detroit, MI.

Abstract

STUDY OBJECTIVE:

We determine how well a new Food and Drug Administration-approved single cardiac troponin T (cTnT) Generation 5 baseline measurement below the level of quantification (6 ng/L) and a novel study-derived baseline and 30-minute cTnT Generation 5 algorithm might adequately exclude acute myocardial infarction in patients with suspected acute coronary syndrome in a US emergency department (ED).

METHODS:

Patients presenting with any symptoms suspicious for acute coronary syndrome were enrolled at a single US ED. Baseline and 30-minute blood samples were obtained and cTnT Generation 5 levels were later batch analyzed in an independent core laboratory. Acute myocardial infarction diagnosis was adjudicated by a cardiologist and an emergency physician.

RESULTS:

Of the 569 study patients, 44 (7.7%) had an acute myocardial infarction diagnosis. One hundred sixty-four patients (28.8%) had a presentation cTnT Generation 5 level less than 6 ng/L, and none of these individuals had an acute myocardial infarction (negative predictive value of 100% [95% confidence interval 97.8% to 100.0%] and sensitivity of 100% [95% confidence interval 92.0% to 100.0%]). A baseline cTnT Generation 5 value of less than 8 ng/L and a 30-minute Δ of less than 3 ng/L were present in 221 patients (41.0%), and none had acute myocardial infarction (negative predictive value of 100% [95% confidence interval 98.3% to 100.0%] and sensitivity of 100% [95% confidence interval 92.0% to 100.0%]).

CONCLUSION:

In a single US ED, a single baseline cTnT Generation 5 measurement less than 6 mg/L and values at baseline less than 8 ng/L and a 30-minute Δ of less than 3 ng/L ruled out acute myocardial infarction in 28.8% and 41.0% of patients, respectively. Additional multicenter US studies evaluating these ultrarapid acute myocardial infarction rule-out guidelines are needed, especially to narrow the confidence intervals.

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