Universal definition

What you don’t know

• What difference does the assay make?• Why does hs-troponin allow earlier rule out?

Patient arrivesin the ED: T0

Blood taken30-45 min

ECG10 min

Triage15 min

3h test3h 30 - 3h 45

Result 12h 30

Result 2:5h 30 - 5h 45

4h

Wh y a 3h Te s t Do esn ’ t Redu ce

Admi s s i o n s

THE BEST STUDY

10ng/L

4th Generation troponin T

High sensitivity

3ng/L 5ng/L 14ng/L

ABNORMAL

ABNORMAL

95% CI 96.7 - 99.9%

95% CI 98.5 - 100.0%

ONE-HOUR RULE OUT1,282 patients

0h <12ng/L ANDDelta <3ng/L

63.4% ruled outNPV 99.1%

0h >51ng/LOR delta >4ng/L

14.4% ruled inPPV 77.2%

Others

22.2% patients22.5% had AMI

Sensitivity 96.7%Mueller et al, ESC 2014