Study of 1,049 patients excludes acute myocardial infarction
3 hours after ED presentation with hsTnI

1049-icon-200x200

A study observing 1,049 qualifying patients set out to evaluate the ability of the Beckman Coulter hsTnI assay, using various level-of-quantification (LoQ) cutpoints, to rule out acute myocardial infarction (AMI) within 3 hours of ED presentation in suspected acute coronary syndrome (ACS) patients. The study enrolled adults with >5 minutes of ACS symptoms and an electrocardiogram obtained per standard care. With informed consent obtained, blood samples were collected in heparin at ED admission (baseline), ≥1 to 3, ≥3 to 6, and ≥6 to 9 hours post-admission. Of 1,049 patients meeting the entry criteria, and with baseline and 1- to 3-hour hsTnI results,117 (11.2%) had an adjudicated final diagnosis of AMI.

The study found:

  • There was a 100% negative predictive value (NPV) for AMI in patients presenting >3 hours after the onset of suspected ACS symptoms, with at least two Beckman Coulter Access hsTnI < upper reference limit (URL) and at least one of which is below either the 10 or the 20% LoQ
  • Two hsTnI values 1 to 3 hours apart with both <URL, but also >LoQ had inadequate sensitivity and NPV

At a Glance

1049
Patients met the entry criteria. This number excluded 805 patients from the present retrospective analysis due to a missing baseline or 3-hour blood draw, in addition to excluding 75 patients due to insufficient sample volume
100 %
Negative predictive value for AMI in patients presenting >3 hours after the onset of suspected ACS symptoms, with at least two Beckman Coulter Access hsTnI < upper reference limit (URL) and at least one of which is below either the 10 or the 20% LoQ
11.2 %
Or 117 of the 1,049 had an adjudicated final diagnosis of AMI. AMI patients were typically older, with more cardiovascular risk factors
Source: Peacock, F. W. (2020, August 1). Myocardial Infarction Can Be Safely Excluded by High-sensitivity Troponin I Testing 3 Hours After Emergency Department Presentation. Academic Emergency Medicine | Wiley Online Library. https://onlinelibrary.wiley.com/doi/10.1111/acem.13922