High-sensitivity cardiac troponin I assays in the diagnosis of acute myocardial infarction
Bibliographic record
Abstract
Chest pain is one of the most common presenting symptoms in patients attending the emergency department; yet, less than one in five patients receive a final diagnosis of acute myocardial infarction.1 In patients without ST segment elevation, early exclusion of acute coronary syndrome has the potential to reduce healthcare expenditure in a population with significant resource implications. Previous approaches were hindered by the performance of contemporary troponin assays, which used a decision threshold for the diagnosis of myocardial infarction based on assay imprecision rather than a defined upper reference limit from a healthy population.2 High-sensitivity cardiac troponin assays were first introduced into clinical practice in Europe, Canada, Australia and New Zealand in 2010, and are defined by their ability to measure circulating troponin in the majority of healthy individuals, allowing accurate identification of the reference range, and demonstrating an acceptable level of imprecision at the 99th centile (≤10% coefficient of variation): the recommended decision threshold for acute myocardial infarction in clinical practice.3 Importantly, international guidelines now recommend these assays may be used to rule out the diagnosis of myocardial infarction at an earlier stage which may prevent unnecessary hospital admission.3 ,4 However, as there are a number of different high-sensitivity cardiac troponin assays from different manufacturers, each with their own strengths and limitations, it is essential clinicians are aware of their unique characteristics to allow optimal and safe use in clinical practice. In their expert consensus document, Tan et al 5 provide a systematic approach to the optimal use of high-sensitivity cardiac troponin I assays for the Asia-Pacific region, including a hybrid diagnostic algorithm for both rule-in and rule-out of myocardial infarction. In line with other international guidelines, they recommend cardiac troponin as the biomarker of choice in patients with suspected acute coronary syndrome, with …
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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; both teacher heads agree on what is shown here.
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".