2-Hour Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker

Abstract

Using the ADP, a large group of patients was successfully identified as at low short-term risk of a MACE and therefore suitable for rapid discharge from the emergency department with early follow-up. This approach could decrease the observation period required for some patients with chest pain. (An observational study of the diagnostic utility of an accelerated diagnostic protocol using contemporary central laboratory cardiac troponin in the assessment of patients presenting to two Australasian hospitals with chest pain of possible cardiac origin; ACTRN12611001069943).

Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay

“…Thereby, the high-sensitivity cardiac troponin T 1-hour algorithm was even more effective in the early triage of patients with acute chest pain than, for example, the recently developed accelerated diagnostic protocol combining the Thrombolysis in Myocardial Infarction Score with high-sensitivity cardiac troponin levels at baseline and 2 hours, or the dual-marker approach combining high-sensitivity cardiac troponin with copeptin, which assign 20%-40% of patients for rapid rule-out. [20][21][22][23][24][25][26][27] This difference is at least partly explained by the fact that the latter approaches exclusively select patients for rule-out, but do not provide guidance for rule-in.…”

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

“…Algorytm ten umożliwiał bezpieczne wykluczenie NSTE-ACS u nawet 40% pacjentów [56][57][58]. W drugim algorytmie, opartym na strategii dwóch markerów -połączenia prawidłowego stężenia troponin sercowych z niskim stężeniem kopeptyny (< 10 pmol/l) przy przyjęciu -wykazywało bardzo dużą ujemną wartość predykcyjną dla MI.…”

High sensitivity cardiac troponin assays in the clinical laboratories

“…The constantly increasing sensitivity and associated higher precision of novel cTn assays allows for gradual reduction in time intervals between onset of symptoms and detection of cTn positivity [61]. Hs assays may allow reduction of the recommended 3-h intervals to 2 h [62]. However, after an attempt to further shorten the initial interval to 1½ h, investigators concluded that testing at 3 h is superior to testing at 90 min [63].…”