Friday, October 22, 2021

High-Sensitivity Troponin

REBEL EM - October 21, 2021 - By Olayode Owoade
Paper: Greenslade JH et al. Diagnostic Accuracy of a New High-Sensitivity Troponin I Assay and Five Accelerated Diagnostic Pathways for Ruling Out Acute Myocardial Infarction and Acute Coronary Syndrome. Ann Emerg Med. 2018. PMID: 29248334
Clinical Question: Do diagnostic chest pain pathways commonly used to rule out AMI and/or ACS remain effective when used with a newer high sensitivity troponin assay (Access hs-TnI)?
Author Conclusion:In this cohort with a low prevalence of acute myocardial infarction and acute coronary syndrome, the use of Access hs-TnI results with either the Vancouver Chest Pain rule or the No Objective Testing Rule enabled approximately one-third of patients to be safely discharged after 2-hour risk stratification with no further testing. The use of this assay within the EDACS, m-ADAPT, or HEART rule pathways enabled more than half of ED patients to be rapidly referred for objective testing.”
Clinical Bottom Line:
The results from retrospective application of the Beckman-Coulter Access high sensitivity troponin assay in the Vancouver Chest Pain rule, NOT, m-ADAPT, EDACS, and HEART pathways were promising. Many of these decision rules have subsequently undergone further validation in prospective trials. In 2017 when this paper was released we would have suggested larger prospective trials be performed for further external validation before the widespread use of these CDI’s with hs-TnI.