The utility of presentation and 4-hour high sensitivity troponin I to rule-out XXXX in the emergency department.

@entity662 @entity1 @entity1187 @entity6949 @entity583
OBJECTIVES: International guidance recommends that early serial sampling of high sensitivity troponin be used to accurately identify @entity583 ( @entity583 ) in @entity662 @entity1 . The background evidence for this approach is limited. We evaluated whether on presentation and 4-hour high-sensitivity troponin I (hs- @entity6949 ) could be used to accurately rule-out @entity583 . DESIGN AND METHODS: hs- @entity6949 was measured on presentation and at 4-hours in adult @entity1 attending an emergency department with possible @entity1187 . We determined the sensitivity for @entity583 for at least one hs- @entity6949 above the 99th percentile for a healthy population or alone or in combination with new ischemic ECG changes. Both overall and sex-specific 99th percentiles were assessed. @entity1 with negative tests were designated low-risk. RESULTS: 63 (17.1%) of 368 @entity1 had @entity583 . The median (interquartile range) time from symptom onset to first blood sampling was 4.8h (2.8-8.6). The sensitivity of the presentation and 4h hs- @entity6949 using the overall 99th percentile was 92.1% (95% CI 82.4% to 97.4%) and negative predictive value 95.4% (92.3% to 97.4%) with 78.3% low-risk. Applying the sex-specific 99th percentile did not change the sensitivity. The addition of ECG did not change the sensitivity. CONCLUSION: Hs- @entity6949 >99th percentile thresholds measured on presentation and at 4-hours was not a safe strategy to rule-out @entity583 in this clinical setting irrespective of whether sex-specific 99th percentiles were used, or whether hs- @entity6949 was combined with ECG results.
