Dr Evangelos Giannitsis
Cardiologist, Medical Director of Chest Pain Unit, University Hospital of Heidelberg, Germany

TRAPID-AMI Sub-Study: Single Low Concentration of hs-TnT to Rule Out AMI


  • Non-detectable (very low levels) of hs-Tn is associated with a low likelihood of developing a NSTEMI and has a high NPV (99%) for MI with high safety and a very few MACE events at 30 day follow up


Theoretically, non-detectable troponin is associated with a very low likelihood to have a non-STEMI or to develop a non-STEMI, and following this concept, a Body investigated from the TRAPID-AMI study the concept of 0- and 1-hour testing using 3 different cut-off concentrations: one at the limit of blank, that is 3 ng/L; one at the limit of detection that is now part of the guideline recommendation 2015, at 5ng/L, and finally; at the 99th percentile value of a healthy reference population, that is 14 ng/L.

He found that with all 3 concepts, there was a very low detection rate of infarct, rendering a negative predictive value of more than 99% with a very high safety with very few MACE events at 30-day follow-up. This concept was important for a third of the TRAPID-AMI population which is a representative suspected ACS cohort.

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