• Rahul G Bhat, Michael V Nguyen, Omoyemen Blue, Huyen-Trang Thai, Maria Cacciapuoti, Hayley Harvey, and Rory Spiegel.
• Department of Emergency Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Rd. NW, Washington, DC, United States of America; Department of Emergency Medicine, MedStar Washington Hospital Center, 110 Irving St. NW, Washington, DC, United States of America.
• Am J Emerg Med. 2022 Nov 1; 61: 525552-55.

BackgroundHigh sensitivity troponin assays have become widespread for emergency department evaluation of acute chest pain. We assessed if a high sensitivity troponin under the 99th percentile upper reference limit drawn at 6 h or greater from symptom onset could safely rule out acute coronary syndrome in patients who did not meet the rapid rule-out strategy.MethodsWe conducted a multicenter retrospective study examining emergency department patients with chest pain who did not meet rapid-rule out criteria and were admitted for further evaluation. Among these admitted patients, we assessed the rate of clinically relevant adverse cardiac events (death, cardiac or respiratory arrest, STEMI, or life-threatening arrhythmia) and NSTEMI in patients with high sensitivity troponin less than the 99th percentile value obtained after at least 6 h of chest pain.ResultsOut of 1187 patients admitted, we found 30 clinically relevant adverse cardiac events, all of which occurred in patients admitted for another compelling reason or ischemic ECG. 36 patients had an NSTEMI, of which 33 were identified with high sensitivity troponin greater than 99th percentile upper reference limit within 6 h of chest pain onset. This left 0 clinically relevant adverse cardiac events and 3 NSTEMI among the 429 patients with high sensitivity troponin less than the 99th percentile at 6 h and nonischemic ECG and no other compelling reason for admission.ConclusionThis study assessed patients with chest pain with high sensitivity troponin values between 3 ng/L and the 99th percentile upper reference limit after 6 h of chest pain and found that they have a low rate of clinically relevant adverse cardiac events and NSTEMI.Copyright © 2022 Elsevier Inc. All rights reserved.

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