Ninety-Minute vs 3-h Performance of High-Sensitivity Cardiac Troponin Assays for Predicting Hospitalization for Acute Coronary Syndrome
Bibliographic record
Abstract
To the Editor: In patients undergoing transcoronary ablation for septal hypertrophy, concentrations of high-sensitivity cardiac troponin T(hs-cTnT)1 increase within 15 min of the procedure (1). If this situation translates to patients who present with chest discomfort who are suffering an acute myocardial infarction (AMI), hs-cTnT probed at time zero and at least 3 h later should be adequate to diagnose or exclude AMI (2, 3). Moreover, the kinetics shown in those with septal ablation suggest that an even earlier evaluation might be possible for clinical decision-making (1, 2). To assess the usefulness of early troponin measurements, we assessed the performance of hs-cTnT and hs-cTnI at 90 min and 3 h for predicting hospitalization for acute coronary syndrome (ACS) in patients presenting to the emergency department (ED) within 6 h of chest pain onset. This study included patients enrolled in the RING study (Reducing the time Interval for identifying New Guideline defined MI in patients with suspected ACS in the ED; research ethics board approved) (4) who had EDTA plasma frozen (−80 °C) at presentation (baseline), 90 min, and 3 h (n = 130 patients). Inclusion criteria were: ≥18 years old with onset of ACS symptoms in the past 6 h, blood sample collection ordered by the ED physician for cardiac troponin measurement, informed consent obtained, and availability for telephone follow-up. We excluded patients presenting with ST-elevation myocardial infarction, those referred directly to surgery, trauma patients, and previously enrolled individuals. We followed all patients for 72 h to determine if an ACS hospitalization occurred (combined outcome of AMI or a hospitalization for unstable angina or refractory ischemic cardiac pain, defined as recurrent ischemic symptoms lasting 15 min or more, along with documented electrocardiographic changes indicative of ischemia or leading to a referral for an additional intervention such as thrombolytic therapy or cardiac catheterization or revascularization). An emergency physician and internal medicine specialist independently adjudicated all outcomes and were blinded to the hs-cTnT (lot #157120) and hs-cTnI results (Abbott ARCHITECT precommercial prototype assay measurement after second thaw). We used StatsDirect software for descriptive and nonparametric testing (Mann–Whitney, Friedman, and Conover testing) and Analyse-it software for ROC analyses. A P value of <0.05 was considered significant.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.018 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".