The role of cardiac troponin I in determining the necessity for exercise electrocardiography in low risk patients with chest pain
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Assessment of non-cardiac chest pain places a considerable burden on healthcare resources. The current practice of serial electrocardiographs (ECGs), serum creatinine phosphokinase and by pre-discharge exercise electrocardiography gives an average in-hospital stay of 3.7 days.
This study assess “the use of a sensitive assay for cardiac troponin I (cTnI) to identify a low risk group for whom exercise ECG may not be indicated.
Ninety-five patients with acute chest pain and with peak cTnI <0.1 ng/ml and a non-diagnostic resting ECG were studied. Patients were divided into two groups. Group one had normal range cTnI (<0.03 ng/ml). Group two had minimal elevation of cTnI (0.03 – 0.099 ng/ml). Average follow-up was 172 days.
Nineteen patients had minimal elevation in cTnI of whom five developed significant ST shift on exercise and five had adverse events. No patient with a normal range cTnI had a positive stress test and none suffered an adverse event (p<0.00.1).
CTnI in the normal range can identify patients with acute chest pain who have a negligible event rate and for whom exercise electrcardiography is not required.
KeywordsAcute Coronary Syndrome Cardiac Troponin Acute Chest Pain Minimal Elevation Ischemic Myocardial Injury
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