High-sensitivity troponin allows accurate rapid diagnosis and discharge but it is not a substitute for a comprehensive patient evaluation
High-sensitivity cardiac troponin (hscTn) assays are replacing the older generation methods for the detection of acute myocardial injury. The key advantage is the higher sensitivity and diagnostic accuracy of hscTn assays, leading to a more rapid confirmation or exclusion of acute myocardial infarction (AMI). The 2015 European Society of Cardiology (ESC) guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation (NSTE-ACS) recommend the use of a 0 h/3 h algorithm, but 0 h/1 h rule-in and rule-out protocols have also been proposed . The positive predictive value for MI is 75–80%, mainly due to the confounding effects of a few other cardiac conditions (dysrhythmias, heart failure, etc.) and many other non-cardiac diseases associated with increased hscTn (pulmonary embolism, infections, renal dysfunction, etc.). In a busy Accident & Emergency Department (A&E), where time and space come at a premium, but missing a diagnosis...
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- 1.Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S, Baumgartner H, Gaemperli O, Achenbach S, Agewall S, Badimon L, Baigent C, Bueno H, Bugiardini R, Carerj S, Casselman F, Cuisset T, Erol Ç, Fitzsimons D, Halle M, Hamm C, Hildick-Smith D, Huber K, Iliodromitis E, James S, Lewis BS, Lip GY, Piepoli MF, Richter D, Rosemann T, Sechtem U, Steg PG, Vrints C, Luis Zamorano J, Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (2016) 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 37:267–315CrossRefGoogle Scholar
- 2.Reichlin T, Hochholzer W, Bassetti S, Steuer S, Stelzig C, Hartwiger S, Biedert S, Schaub N, Buerge C, Potocki M, Noveanu M, Breidthardt T, Twerenbold R, Winkler K, Bingisser R, Mueller C (2009) Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 361:858–867CrossRefGoogle Scholar
- 3.Keller T, Zeller T, Peetz D, Tzikas S, Roth A, Czyz E, Bickel C, Baldus S, Warnholtz A, Frohlich M, Sinning CR, Eleftheriadis MS, Wild PS, Schnabel RB, Lubos E, Jachmann N, Genth-Zotz S, Post F, Nicaud V, Tiret L, Lackner KJ, Munzel TF, Blankenberg S (2009) Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 361:868–877CrossRefGoogle Scholar
- 4.Haaf P, Drexler B, Reichlin T, Twerenbold R, Reiter M, Meissner J, Schaub N, Stelzig C, Freese M, Heinzelmann A, Meune C, Balmelli C, Freidank H, Winkler K, Denhaerynck K, Hochholzer W, Osswald S, Mueller C (2012) High-sensitivity cardiac troponin in the distinction of acute myocardial infarction from acute cardiac noncoronary artery disease. Circulation 126:31–40CrossRefGoogle Scholar
- 9.Shah AS, Anand A, Sandoval Y, Lee KK, Smith SW, Adamson PD, Chapman AR, Langdon T, Sandeman D, Vaswani A, Strachan FE, Ferry A, Stirzaker AG, Reid A, Gray AJ, Collinson PO, McAllister DA, Apple FS, Newby DE, Mills NL, High-STEACS Investigators (2015) High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study. Lancet 386:2481–2488CrossRefGoogle Scholar
- 10.Fabbri A, Bachetti C, Ottani F, Morelli A, Benazzi B, Spiezia S, Cortigiani M, Dorizzi R, Jaffe AS, Galvani M. Rapid rule-out of suspected acute coronary syndrome in the Emergency Department by high-sensitivity cardiac Troponin T levels at presentation. Internal Emerg Med 2018. https://doi.org/10.1007/s11739-018-1996-6
- 11.Pickering JW, Than MP, Cullen L, Aldous S, Ter Avest E, Body R, Carlton EW, Collinson P, Dupuy AM, Ekelund U, Eggers KM, Florkowski CM, Freund Y, George P, Goodacre S, Greenslade JH, Jaffe AS, Lord SJ, Mokhtari A, Mueller C, Munro A, Mustapha S, Parsonage W, Peacock WF, Pemberton C, Richards AM, Sanchis J, Staub LP, Troughton R, Twerenbold R, Wildi K, Young J (2017) Rapid rule-out of acute myocardial infarction with a single high-sensitivity cardiac troponin T measurement below the limit of detection: a collaborative meta-analysis. Ann Intern Med 166:715–724CrossRefGoogle Scholar
- 12.National Institute for Health and Care Excellence (2016) Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin. Clinical guideline CG95. NICE, London. https://www.nice.org.uk/guidance/CG95. Accessed 14 July 2017