Rapid Rule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement Below the Limit of Detection: A Collaborative Meta-analysis
Clinical question: Can a single hs-cTnT below limit of detection and nonischemic ECG rule out AMI in adults presenting to the ED with chest pain?
What was already known: Hs-cTnT are used to rapidly rule out acute myocardial infarction.
Methods: Meta-analysis of 27 cohort studies involving adult patients presenting to the ED with ACS in whom an ECG and hs-cTnT measurements were obtained and reported on primary (AMI during hospitalization) and secondary endpoints (major adverse cardiac event or death within 30 days).
Results/implications: In most, but not all settings, patients presenting with concern for ACS with single hs-cTnT below limit of detection and nonischemic ECG had a very low risk of AMI (0.5% of low-risk patients; 98.7% pooled estimate sensitivity) or 30-day MACE (0.25% MACE; 98% pooled estimate sensitivity).
Bottom line: In patients being investigated for ACS, a single hs-cTnT below limit of detection and nonischemic ECG as opposed to serial troponins is a viable strategy to rule out ACS, with a very low risk of acute MI (0.5%) or MACE (0.25%) within 30 days.