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Acute myocardial infarction can be ruled out with a single high-sensitivity cardiac troponin T level
  1. Martin J Holzmann
  1. Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Martin J Holzmann, Karolinska Institutet, Funktion Akut, Karolinska universitetssjukhuset, Huddinge, Stockholm 11534, Sweden; martin.holzmann{at}

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Commentary on: Pickering JW, Than P, Cullen L, et al. Rapid rule-out of acute myocardial infarction with a single high-sensitivity cardiac troponin T measurement below the limit of detection. Ann Intern Med 2017;166:715–24.


Historically, it has been regarded that at least two measurements of cardiac biomarkers, with 6 hours in between, are needed in order to rule out acute myocardial infarction (AMI). With the introduction of high-sensitivity cardiac troponin (hs-cTn) assays, the time it takes to detect signs of myocyte necrosis has shortened considerably.1 In an observational cohort study published in 2014, it was found that the risk of AMI within 30 days was 0.2% if the first high-sensitivity cardiac troponin T (hs-cTnT) measurement was <5 ng/L.2 The authors suggested that it was safe to discharge all patients with chest pain with a non-ischaemic ECG, if the first …

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  • Competing interests MH has received consultancy fees from Actelion and Pfizer.

  • Provenance and peer review Commissioned; internally peer reviewed.