Table 1.

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.