Emerg Med J 30:593-594 doi:10.1136/emermed-2012-201574
  • Short report

Serial high-sensitivity troponin measurements for the rapid exclusion of acute myocardial infarction in low-risk patients

  1. Graham Bayly1
  1. 1Department of Clinical Biochemistry, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  2. 2Academic Department of Emergency Care, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  1. Correspondence to Dr Graham Bayly, Department of Clinical Biochemistry, Level 9 Queens Building, Bristol Royal Infirmary, Bristol, BS2 8HW, UK; graham.bayly{at}
  1. Contributors All authors participated in the clinical protocol development and contributed to the study design. CD collected and analysed the data with support from JRB and GB. CD drafted the manuscript which was further developed and approved by all authors.

  • Accepted 11 July 2012
  • Published Online First 31 July 2012


High-sensitivity troponin assays facilitate the rapid exclusion of acute myocardial infarction (AMI). However, elevated results are also seen in other conditions causing myocardial injury. Serial measurements increase the specificity for AMI, helping to rapidly identify patients for whom revascularisation may be appropriate. In this study, we explore a strategy for rapidly excluding AMI in symptomatic patients using serial high-sensitivity troponin measurements. Main findings: (1) all patients presenting more than 3 h after symptom onset with a negative result had a second negative result; (2) AMI was excluded in all patients with two results falling below the lower limit of detection of a standard troponin assay by 8 h post-symptom onset.


  • Competing interests None.

  • Ethics approval We retrospectively examined routine clinical practice. The study was deemed to be clinical audit and service evaluation, and did not require ethics committee approval. Data were recorded anonymously and in line with NHS Caldicott Guardian principles.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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