Presentations with suspected stable angina are common yet determining an accurate diagnosis is frequently challenging. It is in this context that a role has emerged for the most recent generation of high-sensitivity cardiac troponin assays. High-sensitivity troponin (hsTn) has demonstrated prognostic value in stable outpatients with symptoms suggestive of coronary artery disease (CAD). A. Sharma et al. (McGill University, Montreal, Quebec, Canada) measured single molecule counting high-sensitivity troponin I in symptomatic outpatients in the PROMISE ((Prospective Multicenter Imaging Study for Evaluation of Chest Pain) study. The goal was to evaluate the hypothesis that hsTnI may identify patients who are unlikely to have inducible ischaemia on stress imaging or events and for which therefore testing is unlikely to be beneficial.
increased. Take-home message: The authors identified an hsTnI threshold “that yielded a robust negative predictive value to exclude a higher risk subsequent clinical course which includes inducible ischaemia and clinical events”. These results suggest that hsTnI may be used as an office-based “rule-out” strategy to identify patients who would not be classified as having a high-risk prognosis.