Objective:

To evaluate the performance of sixth-generation high-sensitivity cardiac troponin T in patients with suspected non-ST-segment elevation myocardial infarction (MI).

Key Findings:

• 61% of 987 patients had sixth-generation troponin T concentrations < 13 ng/L at presentation.
• 8% of 987 patients met the primary outcome.
• The sixth-generation assay had a negative predictive value of 99.9% and sensitivity of 99.4% for the primary outcome.
• 41% of 918 patients would be identified as low risk using the sixth-generation assay compared to 17% of 918 patients with the fifth-generation assay.
• 6% of 987 patients were reclassified as not having myocardial injury using the sixth-generation assay.

Interpretation:

The sixth-generation high-sensitivity cardiac troponin T assay may facilitate earlier discharge in low-risk patients by reducing the need for serial testing, as it identifies a larger proportion of patients as low risk compared to the fifth-generation assay.

Limitations:

• The study was not powered to precisely estimate sensitivity, which may affect the reliability of the results.
• Care was guided by current clinical assays rather than the sixth-generation assay, potentially impacting outcomes.
• The cohort was predominantly White (96%) and had a low percentage of female patients (38%), which may limit generalizability.

Conclusion:

Prospective studies are needed to confirm the impact of the sixth-generation assay on reducing serial testing and facilitating earlier discharge.