Diagnostic metrics for each index test
| Tests | AMI | Not AMI | Proportions (%) | Sensitivity (%) | Specificity (%) | Negative predictive value (%) | Positive predictive value (%) | |
|---|---|---|---|---|---|---|---|---|
| hs-cTnI | ||||||||
| (i) hs-cTnI ESC-rule-in | Test positive | 86 | 17 | 9.7% test positive | 65.2 (56.4 to 73.2) | 98.2 (97.1 to 98.9) | 95.2 (93.6 to 96.4) | 83.5 (74.9 to 90.1) |
| Test negative | 46 | 912 | ||||||
| (ii) Rule-out if 0 and 3 h hs-cTnI <26 ng/L (99th percentile threshold) | Test positive | 123 | 60 | 82.8% test negative | 93.2 (87.5 to 96.8) | 93.5 (91.8 to 95.0) | 99.0 (98.1 to 99.5) | 67.2 (60.0 to 74.0) |
| Test negative | 9 | 869 | ||||||
| (iii) Rule-out with 0 h hs-cTnI <2 ng/L (LoD) | Test positive | 132 | 874 | 5.2% Test negative | 100 (95.9 to 100) | 6.0 (4.5 to 7.7) | 100 (90.4 to 100) | 13.1 (11.1 to 15.4) |
| 0 | 55 | |||||||
| hs-cTnT | ||||||||
| (iv) hs-TnT ESC-rule-in | Test positive | 72 | 28 | 10.2% test positive | 53.7 (44.9 to 62.3) | 96.7 (95.3 to 97.8) | 93.0 (91.1 to 94.6) | 72.0 (62.1 to 80.5) |
| Test negative | 62 | 823 | ||||||
| (v) Rule-out if 0 and 3 h hs-cTnT <14 ng/L (99th percentile threshold) | Test positive | 127 | 170 | 69.8% test negative | 94.8 (89.6 to 97.9) | 80.0 (77.2 to 82.7) | 99.0 (97.9 to 99.6) | 42.7 (37.1 to 48.6) |
| Test negative | 7 | 681 | ||||||
| (vi) Rule-out with 0 h hs-cTnT <5 ng/L (LoD) | Test positive | 133 | 553 | 30.4% test negative | 99.3 (95.9 to 100) | 35.0 (31.8 to 38.3) | 99.7 (98.2 to 100) | 19.4 (16.4 to 22.5) |
| Test negative | 1 | 298 | ||||||
Bold text represents primary outcome metrics.
ESC-rule-in: absolute change of ≥50% the 99th percentile at 3 h in patients with a 0 h hs-cTnI concentration ≤99th percentile and a relative change of ≥20% at 3 h in patients with a 0 h hs-cTn concentration >99th percentile.
AMI, acute myocardial infarction; ESC, European Society of Cardiology; hs-cTnI, high-sensitivity cardiac troponin I; hs-cTnT, high-sensitivity cardiac troponin T; LoD, limit of detection.