Table 3

Diagnostic and prognostic performance of the single hs-cTnT strategy and the two HEART scores

N (%)ClassificationIndex episodeDiagnostic performancePrognostic performance
n=1626
90-day AMI or death
Total
n=1711
AMI
n=61
Sensitivity
(95% CI)
Specificity
(95% CI)
NPV or PPV
(95% CI)
LR
(95% CI)
Single hs-cTnT *Rule-out
(<LoD)
569
(33.3%)
0100.0%
(94.1% to 100.0%)
34.5%
(32.2% to 36.8%)
NPV: 100%
(99.4% to 100.0%)
LR−: 0.00/541
(0.0%)
Observation1098
(64.2%)
27LR: 0.7
(0.5 to 0.9)
36/1042
(3.5%)
Rule-in44
(2.6%)
3455.7%
(42.5% to 68.5%)
99.4%
(98.9% to 99.7%)
PPV: 77.3%
(63.8% to 86.8%)
LR+: 92.0
(47.7 to 177.4)
34/43
(79.1%)
The original
HEART score †
Low risk
(0–3 points)
871
(50.9%)
591.8%
(81.9% to 97.3%)
52.5%
(50.0% to 54.9%)
NPV: 99.4%
(98.7% to 99.8%)
LR−: 0.2
(0.1 to 0.4)
6/829
(0.7%)
Intermediate risk
(4–6 points)
760
(44.4%)
38LR: 1.4
(1.2 to 1.7)
43/722
(6.0%)
High risk
(7–10 points)
80
(4.7%)
1829.5%
(18.5% to 42.6%)
96.2%
(95.2% to 97.1%)
PPV: 22.5%
(15.5% to 31.5%)
LR+: 7.9
(5.0 to 12.4)
21/75
(28.0%)
The modified HEART score ‡Low risk
(0–3 points)
639
(37.3%)
198.4%
(91.2% to 100.0%)
38.7%
(36.3% to 41.1%)
NPV: 99.8%
(98.9% to 100.0%)
LR−: 0.04
(0.0 to 0.3)
1/611
(0.2%)
Intermediate risk
(4–6 points)
876
(51.2%)
39LR: 1.3
(1.0 to 1.5)
42/827
(5.1%)
High risk
(7–10 points)
196
(11.5%)
2134.4%
(22.7% to 47.7%)
89.4%
(87.8% to 90.8%)
PPV: 10.7%
(7.6% to 14.9%)
LR+: 3.3
(2.2 to 4.7)
27/188
(14.4%)
  • The three different diagnostic strategies applied in the study population (n=1711). The 2×2 tables used in the calculations of the diagnostic performance are listed in online supplemental table 4.

  • *Single hs-cTnT strategy with hs-cTnT criteria—<LoD rule-out: hs-cTnT <5 ng/L and ≥3 hours symptom onset; single rule-in: hs-cTnT ≥52 ng/L.2

  • †The original HEART score with hs-cTnT criteria—0 point: ≤14 ng/L, 1 point: 15–41 ng/L and 2 points: ≥42 ng/L.11 12

  • ‡The modified HEART score with hs-cTnT criteria—0 point: <5 ng/L, 1 point: 5–14 ng/L and 2 points: >14 ng/L.

  • AMI, acute myocardial infarction; HEART, History, ECG, Age, Risk factors and Troponin score; hs-cTnT, high-sensitivity cardiac troponin T; LoD, limit of detection; LR, likelihood ratio; NPV, negative predictive value; PPV, positive predictive value.