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Chest-Pain Patients and High-Sensitivity Troponin Tests: the New Frontier

By Anton Helman, MD, CCFP(EM), FCFP | on September 18, 2019 | 0 Comment
EM Cases
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ILLUSTRATION: Chris Whissen & shutterstock.com

References

  1. Mahler SA, Stopyra JP, Apple FS, et al. Use of the HEART Pathway with high sensitivity cardiac troponins: a secondary analysis. Clin Biochem. 2017;50(7-8):401-407.
  2. Laureano-Phillips J, Robinson RD, Aryal S, et al. HEART score risk stratification of low-risk chest pain patients in the emergency department: a systematic review and meta-analysis. Ann Emerg Med. 2019;74(2):187-203.
  3. Tomaszewski CA, Nestler D, Shah KH, et al. Clinical policy: critical issues in the evaluation and management of emergency department patients with suspected non-ST-elevation acute coronary syndromes. Ann Emerg Med. 2018;72(5):e65-e106.
  4. Amsterdam EA, Kirk JD, Bluemke DA, et al. Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation. 2010;122(17):1756-1776.
  5. Pauker SG, Kassirer JP. The threshold approach to clinical decision making. N Engl J Med. 1980;302(20):1109-1117.
  6. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction. J Am Coll Cardiol. 2018;72(18):2231-2264.
  7. Wu AH, Jaffe AS, Apple FS, et al. National Academy of Clinical Biochemistry Laboratory Medicine practice guidelines: use of cardiac troponin and B-type natriuretic peptide or N-terminal proB-type natriuretic peptide for etiologies other than acute coronary syndromes and heart failure. Clin Chem. 2007;53(12):2086-2096.
  8. Pickering JW, Than MP, Cullen L, et al. 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. 2017;166(10):715-724.
  9. Reichlin T, Cullen L, Parsonage WA, et al. Two-hour algorithm for triage toward rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Am J Med. 2015;128(4):369-379.e4.
  10. Crowder K, Jones T, Wang D, et al. Operational impact and patient outcomes following implementation of high–sensitivity troponin testing in three urban emergency departments. Ann Emerg Med. 2014;64(4 Suppl.):S110.
  11. Rezaie S. Management and disposition of low risk chest pain. REBEL EM blog website. Accessed Aug. 13, 2019.
  12. Reichlin T, Twerenbold R, Wildi K, et al. Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay. CMAJ. 2015;187(8):E243-E252.
  13. Fox WR, Diercks DB. Troponin assay use in the emergency department for management of patients with potential acute coronary syndrome: current use and future directions. Clin Exp Emerg Med. 2016;3(1):1-8.
  14. Arbab-Zadeh A. Stress testing and non-invasive coronary angiography in patients with suspected coronary artery disease: time for a new paradigm. Heart Int. 2012;7(1):e2.
  15. Foy AJ, Liu G, Davidson WR Jr, et al. Comparative effectiveness of diagnostic testing strategies in emergency department patients with chest pain: an analysis of downstream testing, interventions, and outcomes. JAMA Intern Med. 2015;175(3):428-436.
  16. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(25):e344-426.

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Explore This Issue
ACEP Now: Vol 38 – No 09 – September 2019

Pages: 1 2 3 4 | Single Page

Topics: cardiologyChest PainRisk StratificationTroponin

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About the Author

Anton Helman, MD, CCFP(EM), FCFP

Dr. Helman is an emergency physician at North York General Hospital in Toronto. He is an assistant professor at the University of Toronto, Division of Emergency Medicine, and the education innovation lead at the Schwartz/Reisman Emergency Medicine Institute. He is the founder and host of Emergency Medicine Cases podcast and website (www.emergencymedicinecases.com).

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