Efficacy of ALARRM framework in early myocardial infarction detection

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Created On: 19/12/2025

High-sensitivity cardiac troponin (hs-cTn) currently rely on assay-specific thresholds, deltas, and timing, which complicates emergency decision-making for suspected myocardial infarction (MI).

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What's new?

High-sensitivity cardiac troponin (hs-cTn) currently rely on assay-specific thresholds, deltas, and timing, which complicates emergency decision-making for suspected myocardial infarction (MI).

Key take away

The ALARRM pathway delivers 100% sensitivity for myocardial infarction detection across all hs-cTn assays while offering high specificity and effective early risk stratification in the emergency department.

Background

High-sensitivity cardiac troponin (hs-cTn) currently rely on assay-specific thresholds, deltas, and timing, which complicates emergency decision-making for suspected myocardial infarction (MI). Clinicians face challenges when integrating multiple assay-specific pathways for early MI detection. A laboratory approach for rapid risk-assessment for MI (ALARRM) strategy combines the common change criteria (3C) and the validated clinical chemistry score (CCS) algorithm to streamline risk categorization across different hs-cTn assays.

This study aimed to evaluate the diagnostic performance, sensitivity, specificity, and overall effectiveness of ALARRM pathway in early MI stratification and compare its performance with the European Society of Cardiology (ESC) single-sample assay-specific cutoffs.

Method

The study included 855 individuals who arrived at the emergency department (ED) with symptoms suggestive of acute coronary syndrome and underwent two blood collections, spaced 3 hours apart, for assessment of Abbott and Ortho hs-cTnI, Roche hs-cTnT, as well as glucose and creatinine levels to estimate glomerular filtration rate (eGFR).

Investigators applied the ALARRM algorithm, combining the CCS and 3C, to categorize patients into rule-in or rule-out risk groups. Diagnostic metrics were compared with the ESC single-cutoff criteria for index MI across all three assays.

Result

ALARRM achieved 100% sensitivity for MI across the Abbott, Ortho, and Roche hs-troponin assays, while the ESC single-cutoff method missed four MIs using the Ortho assay.

Specificity exceeded 90% for patients undergoing serial testing.
Overall diagnostic effectiveness reached 61% with Roche, 80% with Abbott, and 89% with Ortho, demonstrating strong performance across platforms.

Conclusion

Investigators concluded the ALARRM pathway as a robust, efficient, and assay-agnostic solution for early MI evaluation. It delivered superior sensitivity, streamlined decision-making, and consistently outperformed ESC single-cutoff criteria, highlighting its value as a standardized diagnostic approach for emergency care settings.