Table 2 Open in new tab Diagnostic...

Algorithm	Sensitivity ((P)	NPV ((P)	Specificity (P)	PPV (P)	Patients ‘ruled out’	False negatives
Patients presenting >3 h from symptom onset
Hs-cTnT < 5 ng/L (comparator WESTCOR)	98.9 (94.0–100.0)	99.6 (97.0–99.9)	34.1 (30.5–37.9)	17.0 (16.2–17.8)	226	1
Hs-cTnT < 7 ng/L	98.9 (94.0–100.0) (P = 1.0)	99.7 (98.1–100.0) (P < 0.001)	54.2 (48.4–56.3) (P < 0.001)	22.7 (21.3–24.2) (P < 0.001)	359	1
Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L	98.9 (94.0–100.0) (P = 1.0)	99.7 (97.9–100.0) (P < 0.001)	48.3 (44.5–52.2) (P < 0.001)	20.7 (19.5–22.0) (P < 0.001)	320	1
Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L	98.9 (94.0–100.0) (P = 1.0)	99.4 (96.2–99.9) (P < 0.001)	27.0 (23.6–30.5) (P < 0.001)	15.6 (14.9–16.3) (P < 0.001)	179	1
Hs-cTnT < 5 ng/L (comparator APACE)	100.0 (97.8–100.0)	100.0 (97.6–100)	22.8 (19.7–26.2)	25.0 (24.3–25.8)	149	0
Hs-cTnT < 7 ng/L	100.0 (97.8–100.0) (P = 1.0)	100.0 (98.7–100) (P = 1.0)	42.7 (38.9–46.6) (P < 0.001)	31.0 (29.6–32.4) (P < 0.001)	279	0
Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L	100.0 (97.8–100.0) (P = 1.0)	100.0 (98.2–100) (P = 1.0)	30.9 (27.4–34.6) (P < 0.001)	27.1 (26.1–28.2) (P < 0.001)	202	0
Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L	100.0 (97.8–100.0) (P = 1.0)	100.0 (96.5–100) (P = 1.0)	16.1 (13.3–19.1) (P < 0.001)	23.5 (22.9–24.1) (P < 0.001)	105	0
Hs-cTnI < 4 ng/L (comparator WESTCOR)	97.8 (92.2–99.7)	99.5 (97.9–99.9)	56.1 (52.2–59.9)	23.3 (21.7–25.0)	372	2
Hs-cTnI < 7 ng/L	95.6 (89.0–98.8) (P = 0.16)	99.2 (97.9–99.7) (P = 0.41)	74.2 (70.7–77.5) (P < 0.001)	33.6 (30.6–36.7) (P < 0.001)	494	4
Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L	97.8 (92.2–99.7) (P = 1.0)	99.5 (98.1–99.9) (P < 0.001)	62.9 (59.1–66.6) (P < 0.001)	26.4 (24.5–28.5) (P < 0.001)	417	2
Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L	98.9 (94.0–100) (P = 0.32)	99.6 (97.1–99.9) (P = 0.74)	35.3 (31.7–39.1) (P < 0.001)	17.3 (16.4–18.1) (P < 0.001)	234	1
Hs-cTnI < 4 ng/L (comparator APACE)	98.2 (94.7–99.6)	99.1 (97.4–99.7)	52.4 (48.5–56.3)	33.8 (32.0–35.7)	348	3
Hs-cTnI < 7 ng/L	96.3 (92.2–98.6) (P = 0.08)	98.7 (97.2–99.4) (P = 0.33)	70.4 (66.7–73.8) (P < 0.001)	44.6 (41.6–47.6) (P < 0.001)	469	6
Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L	98.2 (94.7–99.6) (P = 1.0)	99.0 (97.0–99.7) (P = 0.85)	45.0 (41.1–48.9) (P < 0.001)	30.7 (29.1–32.2) (P < 0.001)	299	3
Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L	99.4 (96.6–100) (P = 0.16)	99.4 (95.7–99.9) (P = 0.71)	23.7 (20.5–27.2) (P < 0.001)	24.4 (23.6–25.5) (P < 0.001)	157	1
Patients presenting ≤ 3 h from symptom onset
Hs-cTnT < 5 ng/L (comparator WESTCOR)	97.1 (85.1–99.9)	98.5 (90.3–99.8)	37.4 (30.2–45.0)	23.8 (21.5–26.2)	66	1
Hs-cTnT < 7 ng/L	94.3 (80.8–99.3) (P = 0.32)	97.9 (92.3–99.5) (P = 0.64)	53.5 (45.8–61.0) (P < 0.001)	29.0 (25.4–32.8) (P < 0.001)	95	2
Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L	100 (90.0–100) (P = 0.32)	100 (P = 0.38)	42.0 (34.5–49.7) (P < 0.001)	25.7 (23.4–28.2) (P = 0.03)	73	0
Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L	97.1 (85.1–99.9) (P = 1.0)	97.3 (83.6–99.6) (P = 0.67)	20.7 (14.9–27.5) (P < 0.001)	19.8 (18.3–21.3) (P < 0.001)	37	1
Hs-cTnT < 5 ng/L (comparator APACE)	100.0 (96.2–100)	100.0 (96.9–100)	33.3 (28.4–38.6)	29.1 (27.5–30.6)	117	0
Hs-cTnT < 7 ng/L	96.8 (91.1–99.3) (P = 0.08)	98.4 (95.2–99.5) (P = 0.02)	50.6 (45.2–55.9) (P < 0.001)	34.3 (31.9–36.9) (P < 0.001)	183	3
Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L	98.9 (94.3–100) (P = 0.32)	99.2 (94.4–99.9) (P = 0.32)	33.4 (28.5–38.6) (P = 0.83)	28.4 (26.9–30.0) (P = 0.96)	120	1
Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L	99.0 (94.3–100) (P = 0.32)	98.5 (90.3–99.8) (P = 0.18)	18.5 (14.6–23.0) (P < 0.001)	24.5 (23.5–25.5) (P < 0.001)	67	1
Hs-cTnI < 4 ng/L (comparator WESTCOR)	91.4 (76.9–98.2)	97.1 (91.7–99.0)	56.9 (49.2–64.4)	29.9 (25.9–34.2)	102	3
Hs-cTnI < 7 ng/L	88.6 (73.3–96.8) (P = 0.32)	96.9 (92.5–98.7) (P = 0.83)	71.3 (63.9–77.9) (P < 0.001)	38.3 (32.3–44.6) (P < 0.001)	128	4
Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L	97.1 (85.1–99.9) (P = 0.32)	99.0 (93.5–99.9) (P = 0.35)	54.7 (47.1–62.1) (P = 0.55)	29.3 (25.9–33.0) (P = 0.78)	100	1
Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L	97.1 (85.1–99.9) (P = 0.16)	97.7 (86.0–99.7) (P = 0.75)	24.7 (18.5–31.8) (P < 0.001)	20.6 (19.0–22.3) (P < 0.001)	44	1
Hs-cTnI < 4 ng/L (comparator APACE)	97.8 (92.3–99.7)	99.1 (96.6–99.8)	62.8 (57.6–67.8)	39.9 (36.7–43.3)	228	2
Hs-cTnI < 7 ng/L	91.2 (83.4–96.1) (P = 0.01)	97.4 (95.1–98.6) (P = 0.06)	82.8 (78.5–86.5) (P < 0.001)	57.2 (51.4–62.9) (P < 0.001)	306	8
Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L	98.9 (94.0–100) (P = 0.56)	99.4 (96.1–99.9) (P = 0.73)	47.8 (42.5–53.1) (P < 0.001)	32.4 (30.2–34.6) (P < 0.001)	173	1
Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L	98.9 (94.0–100) (P = 0.56)	99.0 (93.5–99.9) (P = 0.93)	28.3 (23.7–33.3) (P < 0.001)	25.9 (24.6–27.2) (P < 0.001)	103	1

Algorithm

Sensitivity ((P)

NPV ((P)

Specificity (P)

PPV (P)

Patients ‘ruled out’

False negatives

Patients presenting >3 h from symptom onset

Hs-cTnT < 5 ng/L (comparator WESTCOR)

98.9 (94.0–100.0)

99.6 (97.0–99.9)

34.1 (30.5–37.9)

17.0 (16.2–17.8)

226

Hs-cTnT < 7 ng/L

98.9 (94.0–100.0) (P = 1.0)

99.7 (98.1–100.0) (P < 0.001)

54.2 (48.4–56.3) (P < 0.001)

22.7 (21.3–24.2) (P < 0.001)

359

Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L

98.9 (94.0–100.0) (P = 1.0)

99.7 (97.9–100.0) (P < 0.001)

48.3 (44.5–52.2) (P < 0.001)

20.7 (19.5–22.0) (P < 0.001)

320

Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L

98.9 (94.0–100.0) (P = 1.0)

99.4 (96.2–99.9) (P < 0.001)

27.0 (23.6–30.5) (P < 0.001)

15.6 (14.9–16.3) (P < 0.001)

179

Hs-cTnT < 5 ng/L (comparator APACE)

100.0 (97.8–100.0)

100.0 (97.6–100)

22.8 (19.7–26.2)

25.0 (24.3–25.8)

149

Hs-cTnT < 7 ng/L

100.0 (97.8–100.0) (P = 1.0)

100.0 (98.7–100) (P = 1.0)

42.7 (38.9–46.6) (P < 0.001)

31.0 (29.6–32.4) (P < 0.001)

279

Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L

100.0 (97.8–100.0) (P = 1.0)

100.0 (98.2–100) (P = 1.0)

30.9 (27.4–34.6) (P < 0.001)

27.1 (26.1–28.2) (P < 0.001)

202

Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L

100.0 (97.8–100.0) (P = 1.0)

100.0 (96.5–100) (P = 1.0)

16.1 (13.3–19.1) (P < 0.001)

23.5 (22.9–24.1) (P < 0.001)

105

Hs-cTnI < 4 ng/L (comparator WESTCOR)

97.8 (92.2–99.7)

99.5 (97.9–99.9)

56.1 (52.2–59.9)

23.3 (21.7–25.0)

372

Hs-cTnI < 7 ng/L

95.6 (89.0–98.8) (P = 0.16)

99.2 (97.9–99.7) (P = 0.41)

74.2 (70.7–77.5) (P < 0.001)

33.6 (30.6–36.7) (P < 0.001)

494

Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L

97.8 (92.2–99.7) (P = 1.0)

99.5 (98.1–99.9) (P < 0.001)

62.9 (59.1–66.6) (P < 0.001)

26.4 (24.5–28.5) (P < 0.001)

417

Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L

98.9 (94.0–100) (P = 0.32)

99.6 (97.1–99.9) (P = 0.74)

35.3 (31.7–39.1) (P < 0.001)

17.3 (16.4–18.1) (P < 0.001)

234

Hs-cTnI < 4 ng/L (comparator APACE)

98.2 (94.7–99.6)

99.1 (97.4–99.7)

52.4 (48.5–56.3)

33.8 (32.0–35.7)

348

Hs-cTnI < 7 ng/L

96.3 (92.2–98.6) (P = 0.08)

98.7 (97.2–99.4) (P = 0.33)

70.4 (66.7–73.8) (P < 0.001)

44.6 (41.6–47.6) (P < 0.001)

469

Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L

98.2 (94.7–99.6) (P = 1.0)

99.0 (97.0–99.7) (P = 0.85)

45.0 (41.1–48.9) (P < 0.001)

30.7 (29.1–32.2) (P < 0.001)

299

Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L

99.4 (96.6–100) (P = 0.16)

99.4 (95.7–99.9) (P = 0.71)

23.7 (20.5–27.2) (P < 0.001)

24.4 (23.6–25.5) (P < 0.001)

157

Patients presenting ≤ 3 h from symptom onset

Hs-cTnT < 5 ng/L (comparator WESTCOR)

97.1 (85.1–99.9)

98.5 (90.3–99.8)

37.4 (30.2–45.0)

23.8 (21.5–26.2)

Hs-cTnT < 7 ng/L

94.3 (80.8–99.3) (P = 0.32)

97.9 (92.3–99.5) (P = 0.64)

53.5 (45.8–61.0) (P < 0.001)

29.0 (25.4–32.8) (P < 0.001)

Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L

100 (90.0–100) (P = 0.32)

100 (P = 0.38)

42.0 (34.5–49.7) (P < 0.001)

25.7 (23.4–28.2) (P = 0.03)

Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L

97.1 (85.1–99.9) (P = 1.0)

97.3 (83.6–99.6) (P = 0.67)

20.7 (14.9–27.5) (P < 0.001)

19.8 (18.3–21.3) (P < 0.001)

Hs-cTnT < 5 ng/L (comparator APACE)

100.0 (96.2–100)

100.0 (96.9–100)

33.3 (28.4–38.6)

29.1 (27.5–30.6)

117

Hs-cTnT < 7 ng/L

96.8 (91.1–99.3) (P = 0.08)

98.4 (95.2–99.5) (P = 0.02)

50.6 (45.2–55.9) (P < 0.001)

34.3 (31.9–36.9) (P < 0.001)

183

Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L

98.9 (94.3–100) (P = 0.32)

99.2 (94.4–99.9) (P = 0.32)

33.4 (28.5–38.6) (P = 0.83)

28.4 (26.9–30.0) (P = 0.96)

120

Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L

99.0 (94.3–100) (P = 0.32)

98.5 (90.3–99.8) (P = 0.18)

18.5 (14.6–23.0) (P < 0.001)

24.5 (23.5–25.5) (P < 0.001)

Hs-cTnI < 4 ng/L (comparator WESTCOR)

91.4 (76.9–98.2)

97.1 (91.7–99.0)

56.9 (49.2–64.4)

29.9 (25.9–34.2)

102

Hs-cTnI < 7 ng/L

88.6 (73.3–96.8) (P = 0.32)

96.9 (92.5–98.7) (P = 0.83)

71.3 (63.9–77.9) (P < 0.001)

38.3 (32.3–44.6) (P < 0.001)

128

Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L

97.1 (85.1–99.9) (P = 0.32)

99.0 (93.5–99.9) (P = 0.35)

54.7 (47.1–62.1) (P = 0.55)

29.3 (25.9–33.0) (P = 0.78)

100

Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L

97.1 (85.1–99.9) (P = 0.16)

97.7 (86.0–99.7) (P = 0.75)

24.7 (18.5–31.8) (P < 0.001)

20.6 (19.0–22.3) (P < 0.001)

Hs-cTnI < 4 ng/L (comparator APACE)

97.8 (92.3–99.7)

99.1 (96.6–99.8)

62.8 (57.6–67.8)

39.9 (36.7–43.3)

228

Hs-cTnI < 7 ng/L

91.2 (83.4–96.1) (P = 0.01)

97.4 (95.1–98.6) (P = 0.06)

82.8 (78.5–86.5) (P < 0.001)

57.2 (51.4–62.9) (P < 0.001)

306

Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L

98.9 (94.0–100) (P = 0.56)

99.4 (96.1–99.9) (P = 0.73)

47.8 (42.5–53.1) (P < 0.001)

32.4 (30.2–34.6) (P < 0.001)

173

Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L

98.9 (94.0–100) (P = 0.56)

99.0 (93.5–99.9) (P = 0.93)

28.3 (23.7–33.3) (P < 0.001)

25.9 (24.6–27.2) (P < 0.001)

103

Algorithm	Sensitivity ((P)	NPV ((P)	Specificity (P)	PPV (P)	Patients ‘ruled out’	False negatives
Patients presenting >3 h from symptom onset
Hs-cTnT < 5 ng/L (comparator WESTCOR)	98.9 (94.0–100.0)	99.6 (97.0–99.9)	34.1 (30.5–37.9)	17.0 (16.2–17.8)	226	1
Hs-cTnT < 7 ng/L	98.9 (94.0–100.0) (P = 1.0)	99.7 (98.1–100.0) (P < 0.001)	54.2 (48.4–56.3) (P < 0.001)	22.7 (21.3–24.2) (P < 0.001)	359	1
Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L	98.9 (94.0–100.0) (P = 1.0)	99.7 (97.9–100.0) (P < 0.001)	48.3 (44.5–52.2) (P < 0.001)	20.7 (19.5–22.0) (P < 0.001)	320	1
Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L	98.9 (94.0–100.0) (P = 1.0)	99.4 (96.2–99.9) (P < 0.001)	27.0 (23.6–30.5) (P < 0.001)	15.6 (14.9–16.3) (P < 0.001)	179	1
Hs-cTnT < 5 ng/L (comparator APACE)	100.0 (97.8–100.0)	100.0 (97.6–100)	22.8 (19.7–26.2)	25.0 (24.3–25.8)	149	0
Hs-cTnT < 7 ng/L	100.0 (97.8–100.0) (P = 1.0)	100.0 (98.7–100) (P = 1.0)	42.7 (38.9–46.6) (P < 0.001)	31.0 (29.6–32.4) (P < 0.001)	279	0
Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L	100.0 (97.8–100.0) (P = 1.0)	100.0 (98.2–100) (P = 1.0)	30.9 (27.4–34.6) (P < 0.001)	27.1 (26.1–28.2) (P < 0.001)	202	0
Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L	100.0 (97.8–100.0) (P = 1.0)	100.0 (96.5–100) (P = 1.0)	16.1 (13.3–19.1) (P < 0.001)	23.5 (22.9–24.1) (P < 0.001)	105	0
Hs-cTnI < 4 ng/L (comparator WESTCOR)	97.8 (92.2–99.7)	99.5 (97.9–99.9)	56.1 (52.2–59.9)	23.3 (21.7–25.0)	372	2
Hs-cTnI < 7 ng/L	95.6 (89.0–98.8) (P = 0.16)	99.2 (97.9–99.7) (P = 0.41)	74.2 (70.7–77.5) (P < 0.001)	33.6 (30.6–36.7) (P < 0.001)	494	4
Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L	97.8 (92.2–99.7) (P = 1.0)	99.5 (98.1–99.9) (P < 0.001)	62.9 (59.1–66.6) (P < 0.001)	26.4 (24.5–28.5) (P < 0.001)	417	2
Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L	98.9 (94.0–100) (P = 0.32)	99.6 (97.1–99.9) (P = 0.74)	35.3 (31.7–39.1) (P < 0.001)	17.3 (16.4–18.1) (P < 0.001)	234	1
Hs-cTnI < 4 ng/L (comparator APACE)	98.2 (94.7–99.6)	99.1 (97.4–99.7)	52.4 (48.5–56.3)	33.8 (32.0–35.7)	348	3
Hs-cTnI < 7 ng/L	96.3 (92.2–98.6) (P = 0.08)	98.7 (97.2–99.4) (P = 0.33)	70.4 (66.7–73.8) (P < 0.001)	44.6 (41.6–47.6) (P < 0.001)	469	6
Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L	98.2 (94.7–99.6) (P = 1.0)	99.0 (97.0–99.7) (P = 0.85)	45.0 (41.1–48.9) (P < 0.001)	30.7 (29.1–32.2) (P < 0.001)	299	3
Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L	99.4 (96.6–100) (P = 0.16)	99.4 (95.7–99.9) (P = 0.71)	23.7 (20.5–27.2) (P < 0.001)	24.4 (23.6–25.5) (P < 0.001)	157	1
Patients presenting ≤ 3 h from symptom onset
Hs-cTnT < 5 ng/L (comparator WESTCOR)	97.1 (85.1–99.9)	98.5 (90.3–99.8)	37.4 (30.2–45.0)	23.8 (21.5–26.2)	66	1
Hs-cTnT < 7 ng/L	94.3 (80.8–99.3) (P = 0.32)	97.9 (92.3–99.5) (P = 0.64)	53.5 (45.8–61.0) (P < 0.001)	29.0 (25.4–32.8) (P < 0.001)	95	2
Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L	100 (90.0–100) (P = 0.32)	100 (P = 0.38)	42.0 (34.5–49.7) (P < 0.001)	25.7 (23.4–28.2) (P = 0.03)	73	0
Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L	97.1 (85.1–99.9) (P = 1.0)	97.3 (83.6–99.6) (P = 0.67)	20.7 (14.9–27.5) (P < 0.001)	19.8 (18.3–21.3) (P < 0.001)	37	1
Hs-cTnT < 5 ng/L (comparator APACE)	100.0 (96.2–100)	100.0 (96.9–100)	33.3 (28.4–38.6)	29.1 (27.5–30.6)	117	0
Hs-cTnT < 7 ng/L	96.8 (91.1–99.3) (P = 0.08)	98.4 (95.2–99.5) (P = 0.02)	50.6 (45.2–55.9) (P < 0.001)	34.3 (31.9–36.9) (P < 0.001)	183	3
Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L	98.9 (94.3–100) (P = 0.32)	99.2 (94.4–99.9) (P = 0.32)	33.4 (28.5–38.6) (P = 0.83)	28.4 (26.9–30.0) (P = 0.96)	120	1
Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L	99.0 (94.3–100) (P = 0.32)	98.5 (90.3–99.8) (P = 0.18)	18.5 (14.6–23.0) (P < 0.001)	24.5 (23.5–25.5) (P < 0.001)	67	1
Hs-cTnI < 4 ng/L (comparator WESTCOR)	91.4 (76.9–98.2)	97.1 (91.7–99.0)	56.9 (49.2–64.4)	29.9 (25.9–34.2)	102	3
Hs-cTnI < 7 ng/L	88.6 (73.3–96.8) (P = 0.32)	96.9 (92.5–98.7) (P = 0.83)	71.3 (63.9–77.9) (P < 0.001)	38.3 (32.3–44.6) (P < 0.001)	128	4
Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L	97.1 (85.1–99.9) (P = 0.32)	99.0 (93.5–99.9) (P = 0.35)	54.7 (47.1–62.1) (P = 0.55)	29.3 (25.9–33.0) (P = 0.78)	100	1
Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L	97.1 (85.1–99.9) (P = 0.16)	97.7 (86.0–99.7) (P = 0.75)	24.7 (18.5–31.8) (P < 0.001)	20.6 (19.0–22.3) (P < 0.001)	44	1
Hs-cTnI < 4 ng/L (comparator APACE)	97.8 (92.3–99.7)	99.1 (96.6–99.8)	62.8 (57.6–67.8)	39.9 (36.7–43.3)	228	2
Hs-cTnI < 7 ng/L	91.2 (83.4–96.1) (P = 0.01)	97.4 (95.1–98.6) (P = 0.06)	82.8 (78.5–86.5) (P < 0.001)	57.2 (51.4–62.9) (P < 0.001)	306	8
Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L	98.9 (94.0–100) (P = 0.56)	99.4 (96.1–99.9) (P = 0.73)	47.8 (42.5–53.1) (P < 0.001)	32.4 (30.2–34.6) (P < 0.001)	173	1
Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L	98.9 (94.0–100) (P = 0.56)	99.0 (93.5–99.9) (P = 0.93)	28.3 (23.7–33.3) (P < 0.001)	25.9 (24.6–27.2) (P < 0.001)	103	1

Algorithm

Sensitivity ((P)

NPV ((P)

Specificity (P)

PPV (P)

Patients ‘ruled out’

False negatives

Patients presenting >3 h from symptom onset

Hs-cTnT < 5 ng/L (comparator WESTCOR)

98.9 (94.0–100.0)

99.6 (97.0–99.9)

34.1 (30.5–37.9)

17.0 (16.2–17.8)

226

Hs-cTnT < 7 ng/L

98.9 (94.0–100.0) (P = 1.0)

99.7 (98.1–100.0) (P < 0.001)

54.2 (48.4–56.3) (P < 0.001)

22.7 (21.3–24.2) (P < 0.001)

359

Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L

98.9 (94.0–100.0) (P = 1.0)

99.7 (97.9–100.0) (P < 0.001)

48.3 (44.5–52.2) (P < 0.001)

20.7 (19.5–22.0) (P < 0.001)

320

Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L

98.9 (94.0–100.0) (P = 1.0)

99.4 (96.2–99.9) (P < 0.001)

27.0 (23.6–30.5) (P < 0.001)

15.6 (14.9–16.3) (P < 0.001)

179

Hs-cTnT < 5 ng/L (comparator APACE)

100.0 (97.8–100.0)

100.0 (97.6–100)

22.8 (19.7–26.2)

25.0 (24.3–25.8)

149

Hs-cTnT < 7 ng/L

100.0 (97.8–100.0) (P = 1.0)

100.0 (98.7–100) (P = 1.0)

42.7 (38.9–46.6) (P < 0.001)

31.0 (29.6–32.4) (P < 0.001)

279

Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L

100.0 (97.8–100.0) (P = 1.0)

100.0 (98.2–100) (P = 1.0)

30.9 (27.4–34.6) (P < 0.001)

27.1 (26.1–28.2) (P < 0.001)

202

Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L

100.0 (97.8–100.0) (P = 1.0)

100.0 (96.5–100) (P = 1.0)

16.1 (13.3–19.1) (P < 0.001)

23.5 (22.9–24.1) (P < 0.001)

105

Hs-cTnI < 4 ng/L (comparator WESTCOR)

97.8 (92.2–99.7)

99.5 (97.9–99.9)

56.1 (52.2–59.9)

23.3 (21.7–25.0)

372

Hs-cTnI < 7 ng/L

95.6 (89.0–98.8) (P = 0.16)

99.2 (97.9–99.7) (P = 0.41)

74.2 (70.7–77.5) (P < 0.001)

33.6 (30.6–36.7) (P < 0.001)

494

Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L

97.8 (92.2–99.7) (P = 1.0)

99.5 (98.1–99.9) (P < 0.001)

62.9 (59.1–66.6) (P < 0.001)

26.4 (24.5–28.5) (P < 0.001)

417

Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L

98.9 (94.0–100) (P = 0.32)

99.6 (97.1–99.9) (P = 0.74)

35.3 (31.7–39.1) (P < 0.001)

17.3 (16.4–18.1) (P < 0.001)

234

Hs-cTnI < 4 ng/L (comparator APACE)

98.2 (94.7–99.6)

99.1 (97.4–99.7)

52.4 (48.5–56.3)

33.8 (32.0–35.7)

348

Hs-cTnI < 7 ng/L

96.3 (92.2–98.6) (P = 0.08)

98.7 (97.2–99.4) (P = 0.33)

70.4 (66.7–73.8) (P < 0.001)

44.6 (41.6–47.6) (P < 0.001)

469

Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L

98.2 (94.7–99.6) (P = 1.0)

99.0 (97.0–99.7) (P = 0.85)

45.0 (41.1–48.9) (P < 0.001)

30.7 (29.1–32.2) (P < 0.001)

299

Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L

99.4 (96.6–100) (P = 0.16)

99.4 (95.7–99.9) (P = 0.71)

23.7 (20.5–27.2) (P < 0.001)

24.4 (23.6–25.5) (P < 0.001)

157

Patients presenting ≤ 3 h from symptom onset

Hs-cTnT < 5 ng/L (comparator WESTCOR)

97.1 (85.1–99.9)

98.5 (90.3–99.8)

37.4 (30.2–45.0)

23.8 (21.5–26.2)

Hs-cTnT < 7 ng/L

94.3 (80.8–99.3) (P = 0.32)

97.9 (92.3–99.5) (P = 0.64)

53.5 (45.8–61.0) (P < 0.001)

29.0 (25.4–32.8) (P < 0.001)

Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L

100 (90.0–100) (P = 0.32)

100 (P = 0.38)

42.0 (34.5–49.7) (P < 0.001)

25.7 (23.4–28.2) (P = 0.03)

Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L

97.1 (85.1–99.9) (P = 1.0)

97.3 (83.6–99.6) (P = 0.67)

20.7 (14.9–27.5) (P < 0.001)

19.8 (18.3–21.3) (P < 0.001)

Hs-cTnT < 5 ng/L (comparator APACE)

100.0 (96.2–100)

100.0 (96.9–100)

33.3 (28.4–38.6)

29.1 (27.5–30.6)

117

Hs-cTnT < 7 ng/L

96.8 (91.1–99.3) (P = 0.08)

98.4 (95.2–99.5) (P = 0.02)

50.6 (45.2–55.9) (P < 0.001)

34.3 (31.9–36.9) (P < 0.001)

183

Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L

98.9 (94.3–100) (P = 0.32)

99.2 (94.4–99.9) (P = 0.32)

33.4 (28.5–38.6) (P = 0.83)

28.4 (26.9–30.0) (P = 0.96)

120

Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L

99.0 (94.3–100) (P = 0.32)

98.5 (90.3–99.8) (P = 0.18)

18.5 (14.6–23.0) (P < 0.001)

24.5 (23.5–25.5) (P < 0.001)

Hs-cTnI < 4 ng/L (comparator WESTCOR)

91.4 (76.9–98.2)

97.1 (91.7–99.0)

56.9 (49.2–64.4)

29.9 (25.9–34.2)

102

Hs-cTnI < 7 ng/L

88.6 (73.3–96.8) (P = 0.32)

96.9 (92.5–98.7) (P = 0.83)

71.3 (63.9–77.9) (P < 0.001)

38.3 (32.3–44.6) (P < 0.001)

128

Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L

97.1 (85.1–99.9) (P = 0.32)

99.0 (93.5–99.9) (P = 0.35)

54.7 (47.1–62.1) (P = 0.55)

29.3 (25.9–33.0) (P = 0.78)

100

Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L

97.1 (85.1–99.9) (P = 0.16)

97.7 (86.0–99.7) (P = 0.75)

24.7 (18.5–31.8) (P < 0.001)

20.6 (19.0–22.3) (P < 0.001)

Hs-cTnI < 4 ng/L (comparator APACE)

97.8 (92.3–99.7)

99.1 (96.6–99.8)

62.8 (57.6–67.8)

39.9 (36.7–43.3)

228

Hs-cTnI < 7 ng/L

91.2 (83.4–96.1) (P = 0.01)

97.4 (95.1–98.6) (P = 0.06)

82.8 (78.5–86.5) (P < 0.001)

57.2 (51.4–62.9) (P < 0.001)

306

Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L

98.9 (94.0–100) (P = 0.56)

99.4 (96.1–99.9) (P = 0.73)

47.8 (42.5–53.1) (P < 0.001)

32.4 (30.2–34.6) (P < 0.001)

173

Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L

98.9 (94.0–100) (P = 0.56)

99.0 (93.5–99.9) (P = 0.93)

28.3 (23.7–33.3) (P < 0.001)

25.9 (24.6–27.2) (P < 0.001)

103

Table 2

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Diagnostic performance (percentages with 95% CI) for early identification of NSTEMI for selected algorithms

Algorithm	Sensitivity ((P)	NPV ((P)	Specificity (P)	PPV (P)	Patients ‘ruled out’	False negatives
Patients presenting >3 h from symptom onset
Hs-cTnT < 5 ng/L (comparator WESTCOR)	98.9 (94.0–100.0)	99.6 (97.0–99.9)	34.1 (30.5–37.9)	17.0 (16.2–17.8)	226	1
Hs-cTnT < 7 ng/L	98.9 (94.0–100.0) (P = 1.0)	99.7 (98.1–100.0) (P < 0.001)	54.2 (48.4–56.3) (P < 0.001)	22.7 (21.3–24.2) (P < 0.001)	359	1
Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L	98.9 (94.0–100.0) (P = 1.0)	99.7 (97.9–100.0) (P < 0.001)	48.3 (44.5–52.2) (P < 0.001)	20.7 (19.5–22.0) (P < 0.001)	320	1
Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L	98.9 (94.0–100.0) (P = 1.0)	99.4 (96.2–99.9) (P < 0.001)	27.0 (23.6–30.5) (P < 0.001)	15.6 (14.9–16.3) (P < 0.001)	179	1
Hs-cTnT < 5 ng/L (comparator APACE)	100.0 (97.8–100.0)	100.0 (97.6–100)	22.8 (19.7–26.2)	25.0 (24.3–25.8)	149	0
Hs-cTnT < 7 ng/L	100.0 (97.8–100.0) (P = 1.0)	100.0 (98.7–100) (P = 1.0)	42.7 (38.9–46.6) (P < 0.001)	31.0 (29.6–32.4) (P < 0.001)	279	0
Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L	100.0 (97.8–100.0) (P = 1.0)	100.0 (98.2–100) (P = 1.0)	30.9 (27.4–34.6) (P < 0.001)	27.1 (26.1–28.2) (P < 0.001)	202	0
Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L	100.0 (97.8–100.0) (P = 1.0)	100.0 (96.5–100) (P = 1.0)	16.1 (13.3–19.1) (P < 0.001)	23.5 (22.9–24.1) (P < 0.001)	105	0
Hs-cTnI < 4 ng/L (comparator WESTCOR)	97.8 (92.2–99.7)	99.5 (97.9–99.9)	56.1 (52.2–59.9)	23.3 (21.7–25.0)	372	2
Hs-cTnI < 7 ng/L	95.6 (89.0–98.8) (P = 0.16)	99.2 (97.9–99.7) (P = 0.41)	74.2 (70.7–77.5) (P < 0.001)	33.6 (30.6–36.7) (P < 0.001)	494	4
Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L	97.8 (92.2–99.7) (P = 1.0)	99.5 (98.1–99.9) (P < 0.001)	62.9 (59.1–66.6) (P < 0.001)	26.4 (24.5–28.5) (P < 0.001)	417	2
Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L	98.9 (94.0–100) (P = 0.32)	99.6 (97.1–99.9) (P = 0.74)	35.3 (31.7–39.1) (P < 0.001)	17.3 (16.4–18.1) (P < 0.001)	234	1
Hs-cTnI < 4 ng/L (comparator APACE)	98.2 (94.7–99.6)	99.1 (97.4–99.7)	52.4 (48.5–56.3)	33.8 (32.0–35.7)	348	3
Hs-cTnI < 7 ng/L	96.3 (92.2–98.6) (P = 0.08)	98.7 (97.2–99.4) (P = 0.33)	70.4 (66.7–73.8) (P < 0.001)	44.6 (41.6–47.6) (P < 0.001)	469	6
Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L	98.2 (94.7–99.6) (P = 1.0)	99.0 (97.0–99.7) (P = 0.85)	45.0 (41.1–48.9) (P < 0.001)	30.7 (29.1–32.2) (P < 0.001)	299	3
Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L	99.4 (96.6–100) (P = 0.16)	99.4 (95.7–99.9) (P = 0.71)	23.7 (20.5–27.2) (P < 0.001)	24.4 (23.6–25.5) (P < 0.001)	157	1
Patients presenting ≤ 3 h from symptom onset
Hs-cTnT < 5 ng/L (comparator WESTCOR)	97.1 (85.1–99.9)	98.5 (90.3–99.8)	37.4 (30.2–45.0)	23.8 (21.5–26.2)	66	1
Hs-cTnT < 7 ng/L	94.3 (80.8–99.3) (P = 0.32)	97.9 (92.3–99.5) (P = 0.64)	53.5 (45.8–61.0) (P < 0.001)	29.0 (25.4–32.8) (P < 0.001)	95	2
Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L	100 (90.0–100) (P = 0.32)	100 (P = 0.38)	42.0 (34.5–49.7) (P < 0.001)	25.7 (23.4–28.2) (P = 0.03)	73	0
Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L	97.1 (85.1–99.9) (P = 1.0)	97.3 (83.6–99.6) (P = 0.67)	20.7 (14.9–27.5) (P < 0.001)	19.8 (18.3–21.3) (P < 0.001)	37	1
Hs-cTnT < 5 ng/L (comparator APACE)	100.0 (96.2–100)	100.0 (96.9–100)	33.3 (28.4–38.6)	29.1 (27.5–30.6)	117	0
Hs-cTnT < 7 ng/L	96.8 (91.1–99.3) (P = 0.08)	98.4 (95.2–99.5) (P = 0.02)	50.6 (45.2–55.9) (P < 0.001)	34.3 (31.9–36.9) (P < 0.001)	183	3
Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L	98.9 (94.3–100) (P = 0.32)	99.2 (94.4–99.9) (P = 0.32)	33.4 (28.5–38.6) (P = 0.83)	28.4 (26.9–30.0) (P = 0.96)	120	1
Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L	99.0 (94.3–100) (P = 0.32)	98.5 (90.3–99.8) (P = 0.18)	18.5 (14.6–23.0) (P < 0.001)	24.5 (23.5–25.5) (P < 0.001)	67	1
Hs-cTnI < 4 ng/L (comparator WESTCOR)	91.4 (76.9–98.2)	97.1 (91.7–99.0)	56.9 (49.2–64.4)	29.9 (25.9–34.2)	102	3
Hs-cTnI < 7 ng/L	88.6 (73.3–96.8) (P = 0.32)	96.9 (92.5–98.7) (P = 0.83)	71.3 (63.9–77.9) (P < 0.001)	38.3 (32.3–44.6) (P < 0.001)	128	4
Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L	97.1 (85.1–99.9) (P = 0.32)	99.0 (93.5–99.9) (P = 0.35)	54.7 (47.1–62.1) (P = 0.55)	29.3 (25.9–33.0) (P = 0.78)	100	1
Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L	97.1 (85.1–99.9) (P = 0.16)	97.7 (86.0–99.7) (P = 0.75)	24.7 (18.5–31.8) (P < 0.001)	20.6 (19.0–22.3) (P < 0.001)	44	1
Hs-cTnI < 4 ng/L (comparator APACE)	97.8 (92.3–99.7)	99.1 (96.6–99.8)	62.8 (57.6–67.8)	39.9 (36.7–43.3)	228	2
Hs-cTnI < 7 ng/L	91.2 (83.4–96.1) (P = 0.01)	97.4 (95.1–98.6) (P = 0.06)	82.8 (78.5–86.5) (P < 0.001)	57.2 (51.4–62.9) (P < 0.001)	306	8
Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L	98.9 (94.0–100) (P = 0.56)	99.4 (96.1–99.9) (P = 0.73)	47.8 (42.5–53.1) (P < 0.001)	32.4 (30.2–34.6) (P < 0.001)	173	1
Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L	98.9 (94.0–100) (P = 0.56)	99.0 (93.5–99.9) (P = 0.93)	28.3 (23.7–33.3) (P < 0.001)	25.9 (24.6–27.2) (P < 0.001)	103	1

Algorithm	Sensitivity ((P)	NPV ((P)	Specificity (P)	PPV (P)	Patients ‘ruled out’	False negatives
Patients presenting >3 h from symptom onset
Hs-cTnT < 5 ng/L (comparator WESTCOR)	98.9 (94.0–100.0)	99.6 (97.0–99.9)	34.1 (30.5–37.9)	17.0 (16.2–17.8)	226	1
Hs-cTnT < 7 ng/L	98.9 (94.0–100.0) (P = 1.0)	99.7 (98.1–100.0) (P < 0.001)	54.2 (48.4–56.3) (P < 0.001)	22.7 (21.3–24.2) (P < 0.001)	359	1
Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L	98.9 (94.0–100.0) (P = 1.0)	99.7 (97.9–100.0) (P < 0.001)	48.3 (44.5–52.2) (P < 0.001)	20.7 (19.5–22.0) (P < 0.001)	320	1
Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L	98.9 (94.0–100.0) (P = 1.0)	99.4 (96.2–99.9) (P < 0.001)	27.0 (23.6–30.5) (P < 0.001)	15.6 (14.9–16.3) (P < 0.001)	179	1
Hs-cTnT < 5 ng/L (comparator APACE)	100.0 (97.8–100.0)	100.0 (97.6–100)	22.8 (19.7–26.2)	25.0 (24.3–25.8)	149	0
Hs-cTnT < 7 ng/L	100.0 (97.8–100.0) (P = 1.0)	100.0 (98.7–100) (P = 1.0)	42.7 (38.9–46.6) (P < 0.001)	31.0 (29.6–32.4) (P < 0.001)	279	0
Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L	100.0 (97.8–100.0) (P = 1.0)	100.0 (98.2–100) (P = 1.0)	30.9 (27.4–34.6) (P < 0.001)	27.1 (26.1–28.2) (P < 0.001)	202	0
Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L	100.0 (97.8–100.0) (P = 1.0)	100.0 (96.5–100) (P = 1.0)	16.1 (13.3–19.1) (P < 0.001)	23.5 (22.9–24.1) (P < 0.001)	105	0
Hs-cTnI < 4 ng/L (comparator WESTCOR)	97.8 (92.2–99.7)	99.5 (97.9–99.9)	56.1 (52.2–59.9)	23.3 (21.7–25.0)	372	2
Hs-cTnI < 7 ng/L	95.6 (89.0–98.8) (P = 0.16)	99.2 (97.9–99.7) (P = 0.41)	74.2 (70.7–77.5) (P < 0.001)	33.6 (30.6–36.7) (P < 0.001)	494	4
Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L	97.8 (92.2–99.7) (P = 1.0)	99.5 (98.1–99.9) (P < 0.001)	62.9 (59.1–66.6) (P < 0.001)	26.4 (24.5–28.5) (P < 0.001)	417	2
Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L	98.9 (94.0–100) (P = 0.32)	99.6 (97.1–99.9) (P = 0.74)	35.3 (31.7–39.1) (P < 0.001)	17.3 (16.4–18.1) (P < 0.001)	234	1
Hs-cTnI < 4 ng/L (comparator APACE)	98.2 (94.7–99.6)	99.1 (97.4–99.7)	52.4 (48.5–56.3)	33.8 (32.0–35.7)	348	3
Hs-cTnI < 7 ng/L	96.3 (92.2–98.6) (P = 0.08)	98.7 (97.2–99.4) (P = 0.33)	70.4 (66.7–73.8) (P < 0.001)	44.6 (41.6–47.6) (P < 0.001)	469	6
Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L	98.2 (94.7–99.6) (P = 1.0)	99.0 (97.0–99.7) (P = 0.85)	45.0 (41.1–48.9) (P < 0.001)	30.7 (29.1–32.2) (P < 0.001)	299	3
Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L	99.4 (96.6–100) (P = 0.16)	99.4 (95.7–99.9) (P = 0.71)	23.7 (20.5–27.2) (P < 0.001)	24.4 (23.6–25.5) (P < 0.001)	157	1
Patients presenting ≤ 3 h from symptom onset
Hs-cTnT < 5 ng/L (comparator WESTCOR)	97.1 (85.1–99.9)	98.5 (90.3–99.8)	37.4 (30.2–45.0)	23.8 (21.5–26.2)	66	1
Hs-cTnT < 7 ng/L	94.3 (80.8–99.3) (P = 0.32)	97.9 (92.3–99.5) (P = 0.64)	53.5 (45.8–61.0) (P < 0.001)	29.0 (25.4–32.8) (P < 0.001)	95	2
Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L	100 (90.0–100) (P = 0.32)	100 (P = 0.38)	42.0 (34.5–49.7) (P < 0.001)	25.7 (23.4–28.2) (P = 0.03)	73	0
Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L	97.1 (85.1–99.9) (P = 1.0)	97.3 (83.6–99.6) (P = 0.67)	20.7 (14.9–27.5) (P < 0.001)	19.8 (18.3–21.3) (P < 0.001)	37	1
Hs-cTnT < 5 ng/L (comparator APACE)	100.0 (96.2–100)	100.0 (96.9–100)	33.3 (28.4–38.6)	29.1 (27.5–30.6)	117	0
Hs-cTnT < 7 ng/L	96.8 (91.1–99.3) (P = 0.08)	98.4 (95.2–99.5) (P = 0.02)	50.6 (45.2–55.9) (P < 0.001)	34.3 (31.9–36.9) (P < 0.001)	183	3
Hs-cTnT < 7 ng/L and copeptin < 9 pmol/L	98.9 (94.3–100) (P = 0.32)	99.2 (94.4–99.9) (P = 0.32)	33.4 (28.5–38.6) (P = 0.83)	28.4 (26.9–30.0) (P = 0.96)	120	1
Hs-cTnT < 7 ng/L and glucose < 5.6 mmol/L	99.0 (94.3–100) (P = 0.32)	98.5 (90.3–99.8) (P = 0.18)	18.5 (14.6–23.0) (P < 0.001)	24.5 (23.5–25.5) (P < 0.001)	67	1
Hs-cTnI < 4 ng/L (comparator WESTCOR)	91.4 (76.9–98.2)	97.1 (91.7–99.0)	56.9 (49.2–64.4)	29.9 (25.9–34.2)	102	3
Hs-cTnI < 7 ng/L	88.6 (73.3–96.8) (P = 0.32)	96.9 (92.5–98.7) (P = 0.83)	71.3 (63.9–77.9) (P < 0.001)	38.3 (32.3–44.6) (P < 0.001)	128	4
Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L	97.1 (85.1–99.9) (P = 0.32)	99.0 (93.5–99.9) (P = 0.35)	54.7 (47.1–62.1) (P = 0.55)	29.3 (25.9–33.0) (P = 0.78)	100	1
Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L	97.1 (85.1–99.9) (P = 0.16)	97.7 (86.0–99.7) (P = 0.75)	24.7 (18.5–31.8) (P < 0.001)	20.6 (19.0–22.3) (P < 0.001)	44	1
Hs-cTnI < 4 ng/L (comparator APACE)	97.8 (92.3–99.7)	99.1 (96.6–99.8)	62.8 (57.6–67.8)	39.9 (36.7–43.3)	228	2
Hs-cTnI < 7 ng/L	91.2 (83.4–96.1) (P = 0.01)	97.4 (95.1–98.6) (P = 0.06)	82.8 (78.5–86.5) (P < 0.001)	57.2 (51.4–62.9) (P < 0.001)	306	8
Hs-cTnI < 7 ng/L and copeptin < 9 pmol/L	98.9 (94.0–100) (P = 0.56)	99.4 (96.1–99.9) (P = 0.73)	47.8 (42.5–53.1) (P < 0.001)	32.4 (30.2–34.6) (P < 0.001)	173	1
Hs-cTnI < 7 ng/L and glucose < 5.6 mmol/L	98.9 (94.0–100) (P = 0.56)	99.0 (93.5–99.9) (P = 0.93)	28.3 (23.7–33.3) (P < 0.001)	25.9 (24.6–27.2) (P < 0.001)	103	1

Sensitivity, specificity, NPV, and PPV were calculated for the different cut-off strategies. Significantly improved performance coloured green. Significantly worsened performance coloured red. WESTCOR data on white background. APACE data on grey background. Comparator algorithms is shown in bold.

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