Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay

A rapid strategy to evaluate patient with suspected acute myocardial infarction included a baseline high sensitivity cardiac troponin T level, a repeat level in 1 hour, and observation care for equivocal cases. Within 1 hour, 40% of patients were classified as ruled-in or ruled-out, and 60% went on to observation care. The sensitivity and negative predictive value in the ruled-out group was over 99%. 30-day mortality was 0% in the ruled out group.  (CMAJ 2015. DOI:10.1503 /cmaj.141349)
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