Diagnostic performance of cardiac Troponin I for early rule-in and rule-out of acute myocardial infarction: Results of a prospective multicenter trial☆

Abstract Objectives To compare emergency department TnI serial sampling intervals, determine optimal diagnostic thresholds, and report representative diagnostic performance characteristics for early rule-in and rule-out of MI. Methods We prospectively measured TnI (AccuTnI+3™, Beckman Coulter) at serial time intervals in 1929 subjects with chest pain or equivalent ischemic symptoms suggestive of acute coronary syndromes at 14 medical centers. Diagnosis was adjudicated by an independent central committee. Results TnI ≥ 0.03 ng/mL provided 96.0% sensitivity and 89.4% specificity at 1–3 h after admission, and 94.9% sensitivity and 86.7% specificity at 3–6 h. NPV (rule-out, non-MI) was 99.5% at 1–3 h, and 99.0% at 3–6 h when TnI is Conclusions We report a large multicenter prospective adjudicated trial assessing troponin for early rule-in and rule-out using the Universal Definition of MI and conducted in primary care hospital-associated emergency departments. Our study demonstrates high diagnostic accuracy at early observation times, and reinforces consensus recommendations for sampling on admission and 3 h later, repeated at 6 h when clinical suspicion remains high.