Rapid myocardial infarction rule-out: A single high-sensitivity cardiac troponin I and T threshold strategy for the Chinese emergency department
- Journal
- Clinica chimica acta; international journal of clinical chemistry (Q1)
- Published
- 12 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Yang Fangfang, LinYahui, Zhan Hong, Wang Shukui, Liu Min, Ye Zi, et al.
- PMID
- 42731666
- DOI
- 10.1016/j.cca.2026.121333
Why clinicians should know about it
- Picked for Biochemistry (medical) (paper of the day, 14 September 2026): High-sensitivity troponin assay validation for rapid MI rule-out
Abstract
BACKGROUND: High-sensitivity cardiac troponin (hs-cTn) discerns MI with high sensitivity, facilitating swift ED discharge. Yet, its application in Chinese cohorts is understudied. This study seeks optimal hs-cTnI and hs-cTnT thresholds for low-risk patient identification in Chinese EDs, utilizing Abbott and Roche assays. METHODS: This prospective, observational cohort study included ED patients suspected of having acute coronary syndrome (ACS). Patients with ST-segment elevation myocardial infarction (STEMI) were excluded. Plasma hs-cTnI and hs-cTnT levels were assessed at presentation. This study evaluated the negative predictive value (NPV) of hs-cTn for 30-day adverse events and targeted ≥99% sensitivity and NPV for MI. The outcomes were compared with those of the clinical hs-cTn assay. RESULTS: Among the 1225 enrolled patients, 365 (29.8%) were confirmed to have MI. A derivation hs-cTnI concentration of <5 ng/L provided a sensitivity of 99.2% and negative predictive value of 99.4% for ruling out MI. For hs-cTnT, sensitivity and NPV were both 100% when the concentration was below 5 ng/L for ruling out MI. The proportions of patients classified as low risk were 42.53% for hs-cTnI and 12.98% for hs-cTnT. Both the hs-cTnI and hs-cTnT thresholds demonstrated high sensitivity and NPV in the prediction of 30-day adverse events. Sex-specific rule-out thresholds (hs-cTnI <6 ng/L, hs-cTnT <8 ng/L) exceeded the unified 5 ng/L, whereas no female-specific threshold was superior for either assay. CONCLUSION: Singular assessment of hs-cTnI and hs-cTnT levels is a rapid and reliable strategy for identifying MI, which may facilitate timely patient discharge from the ED.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.