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This paper might give you some of the answers. They used Abbott and Beckman DXi TnI: 2-Hour Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker - The ADAPT Trial Martin Than, et al. Objectives The purpose of this study was to determine whether a new accelerated diagnostic protocol (ADP) for possible cardiac chest pain could identify low-risk patients suitable for early discharge (with follow-up shortly after discharge). Background Patients presenting with possible acute coronary syndrome (ACS), who have a low short-term risk of adverse cardiac events may be suitable for early discharge and shorter hospital stays. Methods This prospective observational study tested an ADP that included pre-test probability scoring by the Thrombolysis In Myocardial Infarction (TIMI) score, electrocardiography, and 0 _ 2 h values of laboratory troponin I as the sole biomarker. Patients presenting with chest pain due to suspected ACS were included. The primary endpoint was major adverse cardiac event (MACE) within 30 days. Results Of 1,975 patients, 302 (15.3%) had a MACE. The ADP classified 392 patients (20%) as low risk. One (0.25%) of these patients had a MACE, giving the ADP a sensitivity of 99.7% (95% confidence interval [CI]: 98.1% to 99.9%), negative predictive value of 99.7% (95% CI: 98.6% to 100.0%), specificity of 23.4% (95% CI: 21.4% to 25.4%), and positive predictive value of 19.0% (95% CI: 17.2% to 21.0%). Many ADP negative patients had further investigations (74.1%), and therapeutic (18.3%) or procedural (2.0%) interventions during the initial hospital attendance and/or 30-day follow-up. Conclusions Using the ADP, a large group of patients was successfully identified as at low short-term risk of a MACE and therefore suitable for rapid discharge from the emergency department with early follow-up. This approach could decrease the observation period required for some patients with chest pain. (An observational study of the diagnostic utility of an accelerated diagnostic protocol using contemporary central laboratory cardiac troponin in the assessment of patients presenting to two Australasian hospitals with chest pain of possible cardiac origin; ACTRN12611001069943) (J Am Coll Cardiol 2012;59:2091-8 Kind regards, Rita Prof. Andrea Rita Horvath, MD, PhD, EurClinChem, FRCPath, FRCPA Past President of the European Federation of Clinical Chemistry and Laboratory Medicine Clinical Director, SEALS North, Department of Clinical Chemistry Level 4, Campus Centre, Prince of Wales Hospital Barker Street, Randwick, NSW 2031, Sydney, Australia Tel: (+612)-9382 9078 Fax: (+612)-9382 9099 Mobile No: (+61)-404 027 843 From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Colley, Michael Sent: Thursday, 29 November 2012 11:08 PM To: [log in to unmask] Subject: 3or 6 hour rule-out hs-troponin protocol In the same vein, is anyone doing "high sensitivity troponins" on Beckman DXI to permit 6 hour rule-out? What sort of performance are you getting? Is the assay adequately robust at these low levels? Michael From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Ryan, Michael Sent: 29 November 2012 09:57 To: [log in to unmask] Subject: 3hour rule-out hs-troponin protocol Dear Colleagues, I have been approached by our A/E team to provide evidence for consideration of the introduction of a 3-hour rule-out protocol for ACS/MI. Our laboratory uses Roche hs-TnT. Naturally, it is driven by the 4-hour wait issue for A/E departments. We currently use an admission and 6-hour protocol. How many Trusts are using a 3 hour protocol and all advice and guidance would be gratefully received. Regards, Michael Ryan ********************************************************************** This email may contain proprietary and/or confidential information and is intended for the use of addressee(s) only. 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