High-sensitivity cardiac troponin T (hs-cTnT) 0-hour/1-hour algorithm
The high-sensitivity cardiac troponin T (hs-cTnT) 0-hour/1-hour algorithm uses hs-cTnT blood concentration at presentation and its absolute 1h change to stratify patients suspected of acute myocardial infarction.

The Calculator is intended to be used for patients presenting to the Emergency Department with Chest Pain aged 18 years or older.
Research authors: Reichlin T, Schindler C, Drexler B, Twerenbold R, Reiter M, Zellweger C, Moehring B, Ziller R, Hoeller R, Gimenez MR, Haaf P, Potocki M, Wildi K, Balmelli C, Freese M, Stelzig C, Freidank H, Osswald S, and Mueller C.
Version: 1.44
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Absolute change of hs-cTnT: ng/L within the first hour

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Model performance:
The high-sensitivity cardiac troponin T(hs-cTnT) 0-hour/1-hour algorithm was reported to achieve a very high negative predictive value for acute myocardial infarction in the rule-out zone, to achieve a high positive predictive value in the rule-in zone, and to be very effective by triaging approximately 75% of patients presenting with suspected acute myocardial infarction to the ED to either rule-out or rule-in classifications.1,2

In 2016, the algorithm was further validated by Mueller et al. in an external mulicenter cohort of 1,282 patients with a 17% rate of acute myocardial infarction.3 Use of hs-cTn assays at presentation and 1 hour later in classified 63% of patients as having no acute myocardial infarction, with a 99.1% NPV (95% CI 98.2% to 99.7%); 14% as having acute myocardial infarction, with a PPV of 77% (95% CI 70.4% to 83.0%); and 22.5% as having an indeterminate classification after 1 hour of testing.

Related references:

  1. Reichlin T, Schindler C, Drexler B, et al. One-hour rule-out and rule-in ofacute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med. 2012;172:1211-1218.
  2. Reichlin T, Twerenbold R, Wildi K, et al. Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction usinga high-sensitivity cardiac troponin T assay. CMAJ. 2015;187:E243-252.
  3. Mueller C, Giannitsis E, Christ M, et al. Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T. Ann Emerg Med. 2016;68(1):76-87.e4.

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