Assessment strategies evaluated in the model
| No | Strategy | Troponin assay | Protocol (hours) | Diagnostic cut-off* | Dynamic cut-off† | Direct rule-in‡ | Direct rule-out§ | Accelerated rule out¶ | Reference |
| 1 | Standard | cTnI | 0/6 | >40.0 | delta<10 | No | No | No | Standard care |
| 2 | hsTnI | hsTnI | 0/2 | >26.2 | delta<2 | No | No | No | 9 11 |
| 3 | hsTnI+LoD | hsTnI | 0/2 | >26.2 | delta<2 | No | Yes | No | 9 12 |
| 4 | hsTnI+ADP | hsTnI | 0/2 | >26.2 | delta<2 | No | No | Yes | 4 9 |
| 5 | hsTnI+LoD+ADP | hsTnI | 0/2 | >26.2 | delta<2 | No | Yes | Yes | 4 9 12 |
| 6 | hsTnI+LoD+ADP +direct rule-in | hsTnI | 0/2 | >26.2 | delta<2 | Yes | Yes | Yes | 4 9 12 18 |
* A troponin value greater than the diagnostic cut-off was considered as elevated.
†A delta between troponin values at different time points of <10 ng/L (cTnI) or 2 ng/L (hsTnI) was used to distinguish and rule-out a rise and/or fall in troponin associated with acute cardiac conditions.
‡Direct rule-in of individuals with a hsTnI value at baseline above 52 ng/L.
§Direct rule-out of individuals with a hsTnI value at baseline below the LoD of 1.2 ng/L.
¶Referring to the modified ADAPT accelerated diagnostic protocol (ADP). Accelerated rule-out applied to individuals with hsTnI values at 0 and 2 hours below the diagnostic cut-off and a TIMI risk score ≤1.
All values in ng/L.
ADAPT, Accelerated Diagnostic protocol to Assess Patients with chest pain symptoms using contemporary Troponin as the only biomarker; cTnI, sensitive cardiac troponin I; hsTnI, high-sensitivity cardiac troponin I; LoD, limit of detection; TIMI, Thrombolysis In Myocardial Infarction.