In Search of the 1-Hour Rule-Out for Acute Myocardial Infarction

Old habits die hard. The study by Hillinger et al. provides a framework for several observations regarding the current state of ADPs for rapid rule-out of ACS. ADPs that incorporate serial assessments of high-sensitivity cardiac troponin appear to provide a viable approach to rule out ACS with sampling over 3 h with a high NPV. The actual interval (1, 2, or 3 h) and optimal thresholds are issues still to be refined for each assay. A dual-marker strategy using copeptin does not provide incremental clinical information beyond high-sensitivity cardiac troponin, and it seems unlikely that other biomarkers will substantially improve the NPV achieved with serial high-sensitivity cardiac troponin testing alone.