1-hour troponin algorithm captures acute MI in high-risk patients

Takeaway

• A 1-hour troponin algorithm effectively captures many cases of acute myocardial infarction (MI) in high-risk patients presenting to a chest pain unit.
• It does not, however, clarify which patients need early percutaneous intervention and it does not rule acute MI in or out in one-third of patients.

Why this matters

• Although this algorithm has proven utility in emergency departments, its use in specialized chest pain or other cardiac clinics has not been reported.

Key results

• 36.9% of the cohort had non-ST elevation MI.
• Algorithm sensitivity for ruling MI out was 99.8% (95% CI, 98.5%-100%), and for rule-in, it was 94.3% (95% CI, 92.6%-95.8%).
• The caveat is that neither rule-in nor rule-out was clarified for 35.7% of patients.
• With these patients included, sensitivity dropped to 82.7% (95% CI, 79.6%-85.6%), and specificity was 47.8% (95% CI, 45.9%-49.4%).
• Algorithm could not distinguish MI with noncoronary vs coronary etiology.

Study design

• Single-centre prospective cohort study, 1317 consecutive patients (median age, 72 years; 38% women) with suspected MI.
• Funding: German Heart Foundation; University Heart Center Freiburg-Bad Krozingen.

Limitations

• Relied on 1 troponin assay, so not generalisable to other assays.