The Particulars: Data indicate that with no quick way to rule out myocardial infarction (MI), patients with chest pain often wait several hours for repeat testing, increasing hospital admissions. Rapid identification of those with chest pain who do not have an MI could save healthcare resources, reduces costs, reduce unnecessary admissions, and help avoid ED crowding.

Data Breakdown:  Study investigators examined data on nearly 15,000 adults who presented with chest pain who underwent at least one high-sensitivity troponin T test. Most (61%) had undetectable troponin levels (<5 ng/L), 21% had a level of 5 to 14 ng/L, and 18% had a level greater than 14 ng/L. Of the 37% of participants admitted to the hospital—with rates ranged from 21% for those with undetectable troponin levels to 82% for those with the highest levels—only 14% were diagnosed with MI. National registry data indicated that only 0.2% of patients had an MI within 30 days of having initially undetectable levels of high-sensitivity troponin T and an ECG that showed no changes indicative of ischemia.

Take Home Pearl: Initially undetectable levels of high-sensitivity troponin T and an ECG showing no changes indicative of ischemia among patients presenting with chest pain appear to rule out virtually all cases of MI.