Rapid myocardial infarction rule-out: A single high-sensitivity cardiac troponin I and T threshold strategy for the Chinese emergency department.

Authors

Yang Fangfang, LinYahui, Zhan Hong, Wang Shukui, Liu Min, Ye Zi, Liu Caidong, Feng Guangxun, Zhang Tao, Zhu Jun, Fu Yenan, Liang Yan, Zhou Zhou

Published in

Clinica chimica acta; international journal of clinical chemistry. Pages 121333. Sep 12, 2026. Epub Sep 12, 2026.

Abstract

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.
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.
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.
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.

PMID:
42731666
Bibliographic data and abstract were imported from PubMed on 13 Sep 2026.

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