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Original article
A novel troponin I rule-out value below the upper reference limit for acute myocardial infarction
  1. Susan M I Goorden1,
  2. Rudi A van Engelen2,
  3. Liza S M Wong2,
  4. Tjeerd van der Ploeg3,
  5. Gerard J E Verdel2,
  6. Madelon M Buijs1
  1. 1Atalmedial Diagnostic Centres, Hoofddorp, The Netherlands
  2. 2Department of Cardiology, Spaarne Gasthuis, Haarlem, The Netherlands
  3. 3Research Centre Linnaeus Institute Spaarne Gasthuis, Haarlem, The Netherlands
  1. Correspondence to Dr Madelon M Buijs, Atalmedial Diagnostic Centres, PO Box 231, Hoofddorp 2130 AE, The Netherlands; m.m.buijs{at}


Objective To determine cut-off values for a recently introduced high sensitive cardiac troponin assay (hs-cTnI) which provide similar sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) for acute myocardial infarction (AMI) as known cut-off values for an hs-cTnT assay.

Methods A prospective observational study was performed. Hs-cTnT (Roche) and hs-cTnI (Abbott) were measured in consecutive patients with symptoms suggestive of AMI. Representative measurements (obtained at least 3 h after chest pain has started) and serial measurements with a time delay between 2.5 h and 4.5 h were used to determine cut-off levels. Two independent clinicians adjudicated the final diagnosis.

Results 1490 patients were included in the study of whom 114 (8%) received a final diagnosis of AMI. Receiver operating characteristics analysis showed no statistically significant differences in the areas under the curve between the two assays. Cut-off values for representative hs-TnI were found to be as follows: rule-out: 10 ng/L (sensitivity: 98.2%; 95% CI 95.7% to 100.0% and NPV: 99.8%; 99.5% to 100.0%); rule-in: 70 ng/L (specificity: 90.8%; 89.3% to 92.4% and PPV: 39.7%; 36.1% to 43.3%). For serial measurements we found a Δ rule-out cut-off value of 20 ng/L (sensitivity: 94.9%; 88.0% to 100.0% and NPV: 98.7%; 96.9% to 100.0%) and Δ rule-in cut-off values of 100 ng/L (specificity: 92.7%; 87.9% to 95.8% and PPV: 57.6%; 39.4% to 74.0%) and 300% (specificity: 93.8%; 90.4% to 97.2% and PPV: 61.3%; 51.1% to 71.5%).

Conclusions Cut-off values for hs-cTnI measurements are determined which allow a similar diagnostic classification as compared with hs-cTnT. Importantly, for a rule-out paradigm this cut-off value is unmistakably lower than the upper reference limit.

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  • SMIG and RAvE contributed equally to this study.

  • Contributors Guarantors: MMB and GJEV. Study concept, design and supervision: all authors. Conduct of the study: SMIG, RAvE and LSMW. Analysis and interpretation of data: SMIG, RAvE, LSMW and TvdP. Drafting of the manuscript: SMIG, RAvE and LSMW. Critical revision of the manuscript for important intellectual content and approval of the final version of the manuscript: all authors.

  • Funding The hs-cTnI reagents were donated by Abbott Diagnostics. The work was further supported by the department of Cardiology of the Spaarne Gasthuis and Atalmedial Diagnostic Centers.

  • Competing interests None declared.

  • Ethics approval Local Ethics Committee Spaarne Gasthuis Haarlem.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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