Prehospital High-Sensitivity Cardiac Troponin Test can rule out MI 

Therefore, they conducted a prespecified secondary analysis of the ACCESS study, in which patients with suspected ACS were assessed in ambulances fitted with Samsung LABGEOIB10 point-of-care analyzers (Samsung) between 2014 and 2018.

Key Findings of the study:

• Among 966 patients with a prehospital hs-cTn measurement, the researchers identified 44% had known ischemic heart disease and 19% had a subsequent MI or cardiac death within the next 30 days. The median hs-cTnI concentration was 4.0 ng/L.
• Overall, they noted that 28.9% of patients had hs-cTnI concentration below the laboratory assay's limit of detection of < 2 ng/L, with a sensitivity of 97.3% and a negative predictive value of 98.2%.
• They also noted that more than half of patients (55.4%) had levels below the rule out threshold of < 5 ng/L, with a sensitivity of 88.5% and negative predictive value of 96.1%.
• They observed similar findings in subgroups with normal ECG and subgroups stratified by age, sex, and smoking status.
• They noted that the negative predictive value was even higher in patients with a normal ECG without known ischemic heart disease (98.3%) who presented within 3 hours of symptom onset (98.8%).

The authors concluded, "Our findings demonstrate how hs-cTn testing might be applied to risk-stratify patients in the prehospital setting".

For further information:

Cooper JG, Ferguson J, Donaldson LA. Could high-sensitivity cardiac troponin testing rule out acute myocardial infarction in the prehospital setting?_ J Am Coll Cardiol_. 2021;78:2392-1294.