International Journal of Medical Advances and Discoveries

International Journal of Medical Advances and Discoveries | Vol. 16, No. 9, September 2025 | pp. 60–67

DOI: 10.46882/2025/IJMAD/000108

Original Research Article

Title: A Multicenter Evaluation of High-Sensitivity Troponin I Decision Thresholds for Accelerating Myocardial Infarction Rule-Out Protocols

Names of Authors: Patricia K. Thorne¹, Mateo Fernandes², Oliver Vance³

Authors’ Affiliations: ¹Emergency Medicine Clinical Trials Consortium, University of Edinburgh, Edinburgh, UK; ²Department of Cardiology, Hospital de Clínicas, São Paulo, Brazil; ³Division of Emergency Medicine, Monash University, Melbourne, Australia

Abstract: Early diagnostic safety for patients presenting to the emergency department (ED) with suspected acute myocardial infarction (AMI) is a vital metric for preventing hospital overcrowding. High-sensitivity cardiac troponin I (hs-cTnI) assays permit rapid evaluation, but consensus on optimal rapid rule-out cutoffs varies across clinical settings. This prospective, observational validation study assessed the safety and efficacy of a 0/1-hour rapid rule-out protocol using a novel hs-cTnI decision threshold (<3 ng/L) in 1850 consecutive patients presenting with acute chest pain. The primary safety endpoint was a missed index AMI or a major adverse cardiac event (MACE) within 30 days. At presentation, 42.1% of patients (n = 779) were eligible for immediate rule-out based on a baseline hs-cTnI <3 ng/L and a non-ischemic electrocardiogram. An additional 18.4% (n = 340) were ruled out after a 1-hour delta change of <2 ng/L. The combined 0/1-hour protocol achieved a diagnostic sensitivity of 99.6% (95% Confidence Interval [98.9%, 99.9%]) and a negative predictive value (NPV) of 99.8% (95% CI [99.4%, 100%]) for AMI. The 30-day MACE rate among ruled-out patients was exceptionally low at 0.16%. Implementation of this protocol effectively reduced the median ED length of stay by 78 minutes compared to traditional 0/3-hour diagnostic protocols (p < 0.001).

Keywords: High-sensitivity troponin, Myocardial infarction, Emergency department, Rule-out protocol, Chest pain, Diagnostic safety

Manuscript Timeline: Received: June 15, 2025; Revised: July 28, 2025; Accepted: August 14, 2025; Published: September 19, 2025

Citation: Thorne, K. P., Fernandes, M., & Vance, O. (2025). A Multicenter Evaluation of High-Sensitivity Troponin I Decision Thresholds for Accelerating Myocardial Infarction Rule-Out Protocols. International Journal of Medical Advances and Discoveries, 16(9), 60–67. doi.org

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