A high-sensitivity troponin T less than 6 ng/L is very good at ruling out myocardial infarction or death in next 30 days

Reference

Sandoval Y, Lewis BR, Mehta RA, et al. Rapid exclusion of acute myocardial injury and infarction with a single high-sensitivity cardiac troponin T in the emergency department: a multicenter United States evaluation. Circulation 2022;145(23):1708-1719.

Synopsis

This Mayo Clinic study used 2 different cohorts to examine the safety of using a high-sensitivity cardiac troponin T (hs-cTnT) cutoff of less than 6 ng/L to identify emergency department (ED) patients with suspected cardiac ischemia who are very unlikely to have myocardial injury in the next 24 hours or to have a myocardial infarction (MI) or death in the next 30 days. The first “biomarker cohort” included 85,610 patients, of whom 11,962 had a hs-cTnT below the cutoff within the first 12 hours after admission. Of this entire group, 0.7% of women and 1.5% of men had evidence of myocardial injury (elevated troponin) in the next 24 hours. The percentages were similar for the approximately 50% of patients who reported chest pain. The second “adjudicated cohort” used medical record review and identified 1979 patients with an hs-cTnT recorded during the first 12 hours of their ED visit, of whom 624 had a result of less than 6 ng/L. Only 1 of these patients (0.2%) had a missed MI at the index visit, and only 2 had a missed MI or death in the next 30 days. Of the 1849 patients who also had a nonischemic electrocardiogram, none had a missed MI at the index visit, and there was only 1 missed MI or death in the next 30 days.