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Undetectable troponin excludes acute MI

Body R. J Am Coll Cardiol. 2011;58:1332-1339.

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Undetectable high-sensitivity cardiac troponin T at presentation has very high negative predictive value, which identifies patients at low risk for adverse events, and may be considered to rule out acute MI, according to a study.

Patients older than 25 years who arrived at the ED with chest pain suspected to be caused by cardiac problems were enrolled in the study. Patients were evaluated with standard troponin T and tested for high-sensitivity cardiac troponin T at presentation, according to the study. Researchers listed the primary outcome to be a diagnosis of acute MI, and followed up patients within 6 months for adverse events.

Researchers found 130 of 703 patients had acute MI. Initially, none of the 130 patients who developed acute MI had undetectable high-sensitivity cardiac troponin T, with sensitivity of 100% (95% CI, 95.1–100) and a negative predictive value of 100% (95% CI, 98.1–100). Overall, 4.3% of patients (n=30) died or had acute MI, 2.1% (n=15) died, 3% (n=21) had acute MI, and six patients with acute MI died after 6 months, according to the study. Researchers then used the same approach with 915 patients in clinical practice, finding only one patient with subsequent elevation who initially had undetectable high-sensitivity cardiac troponin T. Sensitivity was 99.8% (95% CI, 99.1–100) and negative predictive value was 99.4% (95% CI, 96.6–100).

“The focus of this study, in that it attempts to define the value of negative high-sensitivity troponin, represents an important consequence with significant clinical value,” W. Frank Peacock, MD, of the department of emergency medicine at the Cleveland Clinic, said in an accompanying editorial. “In fact, if you consider the annual 6 million Americans who seek treatment at the ED for chest pain and eventually are ruled out for MI, an initially negative troponin will impact more patients than a positive result.”

Disclosures: Dr. Peacock is on the speakers’ bureau for Abbott and Alere; is a consultant for Abbott, Alere, Beckman Coulter, Electrocore, and The Medicines Company; received research grants from Abbott, Alere, Brahms, Corthera, EKR, Nanosphere, and the Medicines Company; and has ownership interest in Comprehensive Research Associates LLC, Vital Sensors, and Emergencies in Medicine LLC.

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