Clinical Use of High-sensitivity Cardiac Troponin in Patients With Suspected Myocardial Infarction

Raphael Twerenbold, MD; Jasper Boeddinghaus, MD; Thomas Nestelberger, MD; Karin Wildi, MD; Maria Rubini Gimenez, MD; Patrick Badertscher, MD; Christian Mueller, MD


J Am Coll Cardiol. 2017;70(8):996-1012. 

In This Article

Over-ruling the Triage Recommendations

hs-cTn–based triage algorithms must always be used in conjunction with detailed clinical assessment and thorough interpretation of the ECG. This synthesis may well result in over-ruling a "rule-out" recommendation provided by the hs-cTn-based algorithms in some patients perceived to be at high-risk of MI. Over-ruling should then lead to the identical process described for patients assigned the observe-zone and should always include an additional hs-cTn measurement at 3 h. In the vast majority of patients, the 3-h measurement will then confirm the rule-out of MI. However, because the novel hs-cTn–based rule-out algorithms have very high, but not perfect, NPV and sensitivity, over-ruling will detect a rare late-rising patient with MI.