High-sensitivity troponin tests are often used to assess acute chest discomfort in emergency departments. For a study, researchers investigated whether individuals who did not qualify for the quick rule-out technique could be securely excluded from having an acute coronary syndrome by a high sensitivity troponin obtained at least 6 hours after the beginning of symptoms and below the 99th percentile upper reference limit.

In multicenter retrospective research, they looked at emergency room patients with chest discomfort who were hospitalized for further testing but did not fulfill the rapid-rule-out criteria. They evaluated the prevalence of clinically relevant adverse cardiac events (death, cardiac or respiratory arrest, STEMI, or life-threatening arrhythmia), as well as NSTEMI, among these admitted patients who had high sensitivity troponin levels that were less than the 99th percentile value found after at least 6 hours of chest pain.

Out of 1,187 patients hospitalized, they discovered 30 clinically meaningful adverse cardiac events, all of which happened in individuals who were there for an ischemia ECG or another compelling cause. With high sensitivity troponin greater than the 99th percentile upper reference limit, 33 out of 36 patients with an NSTEMI were found within 6 hours after the beginning of chest discomfort to have the condition. There were 3 NSTEMI and 0 clinically meaningful adverse cardiac events among the 429 patients with high sensitivity troponin less than the 99th percentile at 6 h, nonischemic ECG, and no other compelling cause for hospitalization.

After 6 hours of chest pain, the study evaluated individuals with high sensitivity troponin readings between 3 ng/L and the 99th percentile upper reference limit and discovered that they had a low risk of clinically meaningful adverse cardiac events and NSTEMI.

Reference: sciencedirect.com/science/article/pii/S073567572200540X