High Sensitivity Troponins in Acute Chest Pain

This month JC will be looking at highly sensitive troponins and their potential applicability when assessing patients in the ED with acute chest pain. According to the CDC’s most current data the chief complaint of “Chest Pain” represents approximately 5.5% of all ED visits and may be as high as 10%. According to a recent study, in-patient or observation unit admission rates for ED patients is pretty high ranging from 40% to 80% which reflects our low risk tolerance for acute chest pain patients. The most recent European Society of Cardiology guidelines (see 3.3.2) recommends the use of high sensitivity troponins and an expedited 0/1 hour diagnostic algorithm with very high negative predictive values.  We have included  the links above as well as three articles that will be critically appraised. Also included, is a recent JACC review article by EVMS’s own Dr. John Brush titled: Troponin Testing for Clinicians.

So, is high-sensitivity troponin ready for prime-time or not? Should make for an interesting discussion and an opportunity to settle our differences at Laser Quest   

Neumann T, et al. Diagnosis of Myocardial Infarction Using a High-Sensitivity Troponin I 1-Hour Algorithm. JAMA Cardiol. 2016 June. Appraisal

 Jaeger C, et al. One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I. Am Heart J. 2016 Jan;171(1):92-102.e1-5. Appraisal

 Mueller C, et al; TRAPID-AMI Investigators. Multi center Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T. Ann Emerg Med. 2016 Jul 68(1): 76-87. Appraisal

 Brush JE Jr, et al. Troponin Testing for Clinicians. J Am Coll Cardiol. 2016 Nov 29;68(21):2365-2375.