Journal Club Summaryrule-out
Methodology: 2.5/5                   

Usefulness:    3.5/5
Reichlin T, Schindler C, Drexler B, et al.
Arch Intern Med. 2012 Sep 10;172(16):1211-8.
This study was a prospective, multicenter derivation and internal validation of a rapid AMI rule-in and rule-out algorithm that involved 872 patients using high-sensitivity cardiac troponin T (hsctnT). The rule-out identified 60% of patients with acute MI in the first hour with sens/NPV = 100% and the rule-in identified 17% of patients with AMI with specificity = 97% and PPV = 84%. Although this test may rapidly rule-in/rule-out AMI, we feel further study is necessary as this study did not describe how they identified acute chest pain patients (which may lead to a selection bias) and had a somewhat subjective reference standard (adjudicated opinion by 2 cardiologists) that was not blinded to the results of the diagnostic test (ie: hsctnT). 
By: Dr. Omer Yusuf