***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: OBJECTIVE The study objective was to compare the incidence and prognosis of acute myocardial infa rct ion when using high-sensitivity cardiac troponin assays instead of a st and ard cardiac troponin assay for the diagnosis of acute myocardial infa rct ion . METHODS In a prospect i ve international multicenter study , we enrolled 1124 consecutive patients presenting with suspected acute myocardial infa rct ion . Final diagnoses were adjudicated by 2 independent cardiologists 2 times using all available clinical information : first using st and ard cardiac troponin levels and second using high-sensitivity cardiac troponin T levels for adjudication . Patients were followed up for a mean of 19±9 months . RESULTS The use of high-sensitivity cardiac troponin T instead of st and ard cardiac troponin result ed in an increase in the incidence of acute myocardial infa rct ion from 18 % to 22 % ( 242 vs 198 patients ) , a relative increase of 22 % . Of the 44 additional acute myocardial infa rct ions , 35 were type 1 acute myocardial infa rct ions and 9 were type 2 acute myocardial infa rct ions . This was accompanied by a reciprocal decrease in the incidence of unstable angina ( unstable angina , 11 % vs 13 % ) . The most pronounced increase was observed in patients adjudicated with cardiac symptoms of origin other than coronary artery disease with cardiomyocyte damage ( 83 vs 31 patients , relative increase of 268 % ) . Cumulative 30-month mortality rates were 4.8 % in patients without acute myocardial infa rct ion , 16.4 % in patients with a small acute myocardial infa rct ion detected only by high-sensitivity cardiac troponin T but not st and ard cardiac troponin , and 23.9 % in patients with a moderate/large acute myocardial infa rct ion according to st and ard cardiac troponin assays and high-sensitivity cardiac troponin T ( P<.001 ) . CONCLUSIONS The introduction of high-sensitivity cardiac troponin assays leads to only a modest increase in the incidence of acute myocardial infa rct ion . The novel sensitive assays identify an additional high-risk group of patients with increased mortality , therefore appropriately classified with acute myocardial infa rct ion ( Advantageous Predictors of Acute Coronary Syndromes Evaluation ; NCT00470587 ) OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of using a point-of-care cardiac marker panel in patients presenting to the emergency department ( ED ) with suspected but not proven acute myocardial infa rct ion ( AMI ) . DESIGN Multicentre pragmatic open r and omised controlled trial and economic evaluation . SETTING Six acute hospital EDs in the UK . PARTICIPANTS Adults presenting to hospital with chest pain due to suspected but not proven myocardial infa rct ion , and no other potentially serious alternative pathology or comorbidity . INTERVENTIONS Participants were allocated using an online r and omisation system to receive either ( 1 ) diagnostic assessment using the point-of-care biochemical marker panel or ( 2 ) conventional diagnostic assessment without the panel . All tests and treatments other than the panel were provided at the discretion of the clinician . MAIN OUTCOME MEASURES The primary outcome was the proportion of patients successfully discharged home after ED assessment , defined as patients who had ( 1 ) either left the hospital or were awaiting transport home with a discharge decision having been made at 4 hours after initial presentation and ( 2 ) suffered no major adverse event ( as defined below ) during the following 3 months . Secondary outcomes included length of initial hospital stay and total inpatient days over 3 months , and major adverse events ( death , non-fatal AMI , life-threatening arrhythmia , emergency revascularisation or hospitalisation for myocardial ischaemia ) . Economic analysis estimated mean costs and quality -adjusted life-years ( QALYs ) , and then estimated the probability of cost-effectiveness assuming willingness to pay of £ 20,000 per QALY gained . RESULTS We r and omised 1132 participants to point of care and 1131 to st and ard care , and analysed 1125 and 1118 , respectively [ mean age 54.5 years , 1307/2243 ( 58 % ) male and 269/2243 ( 12 % ) with known coronary heart disease ( CHD ) ] . In the point-of-care group 358/1125 ( 32 % ) were successfully discharged compared with 146/1118 ( 13 % ) in the st and ard-care group [ odds ratio ( OR ) adjusted for age , gender and history of CHD 3.81 ; 95 % confidence interval ( CI ) 3.01 to 4.82 , p < 0.001 ] . Mean length of the initial hospital stay was 29.6 hours versus 31.8 hours ( mean difference = 2.1 hours ; 95 % CI -3.7 to 8.0 hours , p = 0.462 ) , while median length of initial hospital stay was 8.8 hours versus 14.2 hours ( p < 0.001 ) . More patients in the point-of-care group had no inpatient days recorded during follow-up ( 54 % vs 40 % , p < 0.001 ) , but mean inpatient days did not differ between the two groups ( 1.8 vs 1.7 , p = 0.815 ) . More patients in the point-of-care group were managed on coronary care [ 50/1125 ( 4 % ) vs 31/1118 ( 3 % ) , p = 0.041 ] . There were 36 ( 3 % ) patients with major adverse events in the point-of-care group and 26 ( 2 % ) in the st and ard-care group ( adjusted OR 1.31 ; 95 % CI 0.78 to 2.20 , p = 0.313 ) . Mean costs per patient were £ 1217 with point-of-care versus £ 1006 with st and ard care ( p = 0.056 ) , while mean QALYs were 0.158 versus 0.161 ( p = 0.250 ) . The probability of st and ard care being dominant ( i.e. cheaper and more effective ) was 0.888 . CONCLUSIONS Point-of-care testing increases the proportion of patients successfully discharged home and reduces the median ( but not mean ) length of hospital stay . It is more expensive than st and ard care and unlikely to be considered cost-effective . TRIAL REGISTRATION Current Controlled Trials IS RCT N37823923 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 15 , No. 23 . See the HTA programme website for further project information Objective To investigate whether a high-sensitivity troponin assay , shown to improve early detection of  acute myocardial infa rct ion  ( AMI ) , permits accelerated rule-in/rule-out of AMI . Methods Patients who presented to the emergency department within 4 h of the onset of chest pain suggestive of acute coronary syndrome were prospect ively recruited from November 2007 to April 2010 . Blood sample s were taken at 0 , 1 , 2 and 12–24 h after presentation and were analysed for clinical ly applied troponin I and for high-sensitivity troponin T ( hsTnT ) . The dynamic change in hsTnT levels between time points was measured . The primary outcome was admission diagnosis of AMI . Results Of the 385 patients recruited , 82 ( 21.3 % ) had AMI . The sensitivity of hsTnT  by 2 h was 95.1 % ( 88.7–98.1 % ) , specificity 75.6 % ( 73.8–76.5 % ) , positive predictive value 53.8 % ( 50.2–55.5 % ) and negative predictive value 98.3 % ( 96.0–99.3 % ) . The sensitivity was not statistically different between peak values at 2 h and 24 h. Adding ECG results reduced the false negative rate to 1.2 % . The additional application of ≥20 % delta criterion over the 2 h period for 0–2 h sample s increased specificity to 92.4 % ( 90.2–94.3 % ) but reduced sensitivity to 56.1 % ( 48.0–63.2 % ) . Conclusion hsTnT taken at 0 and 2 h after presentation , together with ECG results , could identify patients suitable for early stress testing with a false negative rate for AMI of 1.2 % . Further trials of such an approach are warranted . The specificity of hsTnT for diagnosing AMI could be improved by the use of a delta of ≥20 % , but at the cost of major reductions in sensitivity Abstract Background : Current hospital practice involves protracted observation of chest-pain patients to rule out myocardial infa rct ion . Concurrent measurement of multiple biomarkers may increase sensitivity and make rapid diagnosis feasible . Objective : We sought to determine the optimal biomarker strategy for highly sensitive , early diagnosis of myocardial injury . Study Design : A prospect i ve evaluation of 171 acute coronary syndrome patients admitted to a single university medical center was performed .  Blood tests for creatine kinase ( CK ) , CK myocardial b and isoenzyme ( CK-MB ) , and troponin T  were obtained at 0 , 3 , 6 , 8 , and 16 hours after presentation to the emergency department . Myocardial injury was defined as a troponin T level of ≥0.03 ng/mL. Results : Troponin T had sensitivities of 79.7 % , 95.7 % , and 98.4 % at the time of initial presentation , 3 and 6 hours after presentation , respectively . Using a combination of troponin T and CK-MB relative index , sensitivity on presentation was increased to 90.6 % . The sensitivity was improved to 97.9 % and 100 % at 3 and 6 hours , respectively . Conclusion : This study demonstrates that the diagnosis of myocardial injury can be accurately excluded within 6 hours of admission with high sensitivity using troponin T. The combination of troponin T and CK-MB relative index provided the largest improvement in diagnostic sensitivity at patient arrival . These results support the feasibility of rapid , efficient triage for the emergent presentation of patients with chest pain BACKGROUND Cardiac troponin T measured by a high-sensitivity assay ( hs-cTnT ) recently proved to be of prognostic value in several population s. The hs-cTnT assay may also improve risk stratification in acute dyspnea . METHODS We prospect ively studied the prognostic value of hs-cTnT in 678 consecutive patients presenting to the emergency department with acute dyspnea . On the basis of conventional cardiac troponin T assay ( cTnT ) and hs-cTnT assay measurements , patients were divided into 3 categories : ( 1 ) neither assay increased ( cTnT<0.03 μg/L , hs-cTnT<0.016 μg/L ) , ( 2 ) only hs-cTnT  increased≥0.016 μg/L ( cTnT<0.03 μg/L ) , and ( 3 ) both assays increased ( cTnT≥0.03 μg/L , hs-cTnT≥0.016 μg/L ) . Moreover , the prognostic value of hs-cTnT was investigated if cTnT was not detectable ( < 0.01 ) . RESULTS One hundred seventy-two patients were in the lowest , 282 patients in the middle , and 223 patients in the highest troponin category . Patients in the second and third categories had significantly higher mortality compared to those in the first category ( 90-day mortality rate 2 % , 10 % , and 26 % in groups 1 , 2 , and 3 , respectively , P<0.001 ; 1-year mortality rate 9 % , 21 % , and 39 % , P<0.001 ) . Importantly , in patients with undetectable cTnT ( n=347 , 51 % ) , increased hs-cTnT indicated worse outcome [ 90-day mortality , odds ratio 4.26 ( 95 % CI 1.19 - 15.21 ) ; 1-year mortality , hazard ratio 2.27 ( 1.19 - 4.36 ) , P=0.013 ] , whereas N-terminal pro-brain-type natriuretic peptide ( NT-proBNP ) was not predictive of short-term outcome . CONCLUSIONS hs-cTnT is associated with mortality in patients presenting with acute dyspnea . hs-cTnT concentrations provide additional prognostic information to cTnT and NT-proBNP testing in patients with cTnT concentrations below the detection limit . In particular , the hs-cTnT cutoff of 0.016 μg/L enables identification of low-risk patients OBJECTIVES The goal of this study was to determine the ability of 
    Output:
    
There is some evidence to suggest that hs-CTn testing may provide an effective and cost-effective approach to early rule-out of AMI .