Overview on the performance of fast rule-out strategies based on single and serial blood draw at 0 hour/1 hour
| Test principle | Company | Meta-analysis cohorts | Troponin (ng/L) | Sensitivity (pooled) | NPV (pooled) | Proportion eligible for rule-out | Event rate after rule-out | |||
| MACE | Death | MI | ||||||||
| 0-hour rule-out: single hs-cTNT <LoD (SMS) | ||||||||||
| Pickering, et al 29 | hs-cTnT | 11 cohorts 9241 patients | <LoD (<5 ng/L) | 98.7% (96.6 to 99.5) | 99.3% (97.3 to 99.8) | 30.60% | 21/8059 | 1.30% | 14/8059 | |
| ESC 0/1 hour: either very low 0 hour <LoD or low hs-cTn and small δ between 0 and 1 hour | ||||||||||
| Chiang, et al
28
15 cohorts: 11 014 patients | hs-cTnI | Abbott | 4 cohorts | Either very low 0 hour (<2 ng/L), or low hs-cTnI (<5 ng/L) and small δ (<2 ng/L) between 0 and 1 hour | 98.1% (94.6 to 99.3) | 99% (96.0 to 100) | 50.00% | NA | 0.10% | NA |
| hs-cTnI | Siemens | 4 cohorts | Either very low 0 hour (<0.5 ng/L), or low hs-cTnI (<5 ng/L) and small δ (<2 ng/L) between 0 and 1 hour | 98.7% (97.3 to 99.3) | 100% (99 to 100) | 51.00% | NA | 0.10% | NA | |
| hs-cTnT | Roche | 7 cohorts 7744 patients | Either very low 0 hour (<5 ng/L), or low hs-cTnT (<12 ng/L) and small δ (<3 ng/L) between 0 and 1 hour | 98.4% (95.1 to 99.5) | 99.6% (99.0 to 99.9) | 55.00% | NA | 0.10% | NA | |
ESC, European Society of Cardiology; hs-cTnI, high-sensitivity cardiac troponin I; LoD, limit of detection; MACE, major adverse cardiac events; MI, myocardial infarction; NA, not available; NPV, negative predictive value; SMS, single marker strategy.