High-sensitivity troponin tests for the early rule out of NSTEMI

The following high-sensitivity troponin tests are recommended as options for the early rule out of non-ST-segment elevation myocardial infarction (NSTEMI) in people presenting to an emergency department with chest pain and suspected acute coronary syndrome:

• Access High-Sensitivity Troponin I Assay

• ADVIA Centaur High-Sensitivity Cardiac Troponin‑I Assay

• Alinity High Sensitive Troponin‑I assay

• ARCHITECT STAT High Sensitive Troponin‑I assay

• Atellica IM High-Sensitivity Cardiac Troponin I Assay

• Dimension Vista High-Sensitivity Cardiac Troponin I Assay

• Dimension EXL High-Sensitivity Cardiac Troponin I Assay

• Elecsys Troponin T-high sensitive assay

• Elecsys Troponin T-high sensitive STAT assay

• VIDAS High sensitive Troponin I assay

• VITROS High Sensitivity Troponin I Assay.

The tests are recommended for use with different early rule-out test strategies alongside clinical judgement, including:

• A single sample on presentation using a threshold at or near the limit of detection, which will vary depending on the assay being used. If this sample is positive it should not be used to rule in NSTEMI.

• Multiple sample strategies, which typically include a sample at initial assessment followed by a second sample taken at 30 minutes to 3 hours (if clinically appropriate) and use of 99th percentile thresholds or thresholds at or near the limit of detection of the assay.
  
  Healthcare professionals should consider the likely time since the onset of symptoms when interpreting test results.

When NSTEMI is not ruled out using early rule-out test strategies, use NICE's guideline on recent-onset chest pain of suspected cardiac origin to help diagnose myocardial infarction, and consider using sex-specific thresholds at the 99th percentile (see section 4.7 and section 5.2).