How Safe Is the Outpatient Management of Patients with Acute Chest Pain and Mildly Increased Cardiac Troponin Concentrations?

Meune, Christophe; Reichlin, Tobias; Irfan, Affan; Schaub, Nora; Twerenbold, Raphael; Meißner, Julia; Reiter, Miriam; Lüthi, Adrian; Haaf, Philip; Balmelli, Cathrin; Drexler, Beatrice; Winkler, Katrin; Hochholzer, Willibald; Oßwald, Stefan; Müeller, Christian

doi:10.1373/clinchem.2011.178053

Cited by 24 publications

(18 citation statements)

References 29 publications

(36 reference statements)

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“…Our findings underscore the robustness of the Roche fifth-generation hs-cTnT assay around the 99th percentile and extend the previously published data on the stability of cTnT in vitro (2,3,5 ). …”

supporting

confidence: 87%

Persistent Increases in Cardiac Troponin Concentrations As Measured with High-Sensitivity Assays after Acute Myocardial Infarction

et al. 2013

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supporting

confidence: 87%

Persistent Increases in Cardiac Troponin Concentrations As Measured with High-Sensitivity Assays after Acute Myocardial Infarction

et al. 2013

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“…Elevated Tn values (including those obtained with highsensitivity assays) are associated with a 2-fold higher risk for longer-term all-cause mortality and cardiovascular death than a negative troponin values (6,(42)(43)(44). This association is dose-dependent.…”

Section: Investigating the Causes Of Positive Troponin Values In Non-mentioning

confidence: 96%

Preparing the United States for High-Sensitivity Cardiac Troponin Assays

Korley

Jaffe

2013

Journal of the American College of Cardiology

127

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It is only a matter of time before the use of high-sensitivity cardiac troponin assays (hs-cTn) becomes common throughout the United States. In preparation for this inevitability, this article raises a number of important issues regarding these assays that deserve consideration. These include: the need for the adoption of a universal nomenclature; the importance of defining uniform criteria for reference populations; the challenge of discriminating between acute and nonacute causes of hs-cTn elevations, and between type 1 and type 2 acute myocardial infarction (AMI); factors influencing the analytical precision of hs-cTn; ascertaining the optimal duration of the rule-out period for AMI; the need for further evaluation to determine the causes of a positive hs-cTn in non-AMI patients; and the use of hs-cTn to risk-stratify patients with disease conditions other than AMI. This review elaborates on these critical issues as a means of educating clinicians and researchers about them.

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“…Importantly, although the rate of discharged patients with at least one hsTn-positive result increased significantly compared with the conventional cTn T assay (26.6% vs. 8.5%), the number of patient readmissions after 2 months of follow-up did not significantly increase [42]. The lack of short-term implications suggests that patients with mildly increased hsTnT concentrations and no signs of ACS do not necessarily need hospitalization, confirming that triage decisions in the ED should not only be based on hsTn results but should be interpreted together with other available clinical information [43].…”

Section: : Increasing Ctn Positivity Ratesmentioning

confidence: 99%

Laboratory medicine as the science that underpins medicine: the “high-sensitivity” troponin paradigm

Ferraro¹,

Panteghini

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:The availability of so-called high-sensitivity troponin assays (hsTn) has scored a compelling goal for laboratory medicine, allowing the safe clinical application of international recommendations for the definition of acute myocardial infarction (AMI). However, the introduction of hsTn has not been welcomed by clinicians, claiming an increase in false-positive results. Here we critically trace back the steps following the introduction of hsTn by referring to the 5-year practical experience in our academic hospital and to suitable information available in the literature. In agreement with published data, we found that hsTn introduction was associated with an increased number of AMI diagnoses, whereas the test volume, the revascularization rate, and the proportion of cases with negative angiography findings remained virtually unchanged. Fast-track protocols for ruling out AMI have been further optimized to recommend sampling at presentation and after 3 h only. We focus on a cost-effective use of hsTn that can account for all clinical variables increasing the pre-test probability in order to ensure that tests are ordered only for patients at medium to high risk for acute coronary syndrome (ACS). To guide interpretation of results, hsTn typical release patterns suggestive for AMI should be identified by evaluating the significance of concentration changes. hsTn have markedly shortened the time to rule out or rule in AMI and has the potential to improve the prognostic assessment of critical patients in clinical contexts different from ACS.

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How Safe Is the Outpatient Management of Patients with Acute Chest Pain and Mildly Increased Cardiac Troponin Concentrations?

Abstract: BACKGROUND:The appropriate management of patients discharged from the emergency department (ED) with increased high-sensitivity cardiac troponin T (hs-cTnT) but normal or borderline-high conventional cardiac troponin concentrations is unknown.

Cited by 24 publications

References 29 publications

Persistent Increases in Cardiac Troponin Concentrations As Measured with High-Sensitivity Assays after Acute Myocardial Infarction

Persistent Increases in Cardiac Troponin Concentrations As Measured with High-Sensitivity Assays after Acute Myocardial Infarction

Preparing the United States for High-Sensitivity Cardiac Troponin Assays

Laboratory medicine as the science that underpins medicine: the “high-sensitivity” troponin paradigm

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