High-Sensitivity Cardiac Troponins and Clinical Decision Making in Caring for Patients With Chest Pain
Authors: Andrew D. McRae, Connor M. O’Rielly, Eddy S. Lang
Journal: Annals of Internal Medicine (2021)

EditorialsJanuary 2022High-Sensitivity Cardiac Troponins and Clinical Decision Making in Caring for Patients With Chest PainAndrew D. McRae, MD, PhD, Connor M. O’Rielly, MSc, Eddy S. Lang, MDAndrew D. McRae, MD, PhDDepartments of Emergency Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this author, Connor M. O’Rielly, MScCumming School of Medicine, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this author, Eddy S. Lang, MDDepartments of Emergency Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, CanadaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-4342 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail New guidelines for the management of patients with chest pain indicate that high-sensitivity cardiac troponin (hs-cTn) assays are the preferred biomarkers for the diagnosis of myocardial injury and recommend that a validated serial testing pathway be used to rule in or rule out acute myocardial infarction (1). In their article, Chiang and colleagues (2) have synthesized data from 20 prospective cohorts of patients undergoing evaluation for chest pain to quantify the diagnostic accuracy and classification performance of 0/1-hour and 0/2-hour rapid diagnostic algorithms using several available hs-cTn assays. This systematic review provides clinicians with the evidence required to use these ...References1. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021:CIR0000000000001030. [PMID: 34709928] doi:10.1161/CIR.0000000000001030 CrossrefMedlineGoogle Scholar2. Chiang CH, Chiang CH, Pickering JW, et al. Performance of the European Society of Cardiology 0/1-hour, 0/2-hour, and 0/3-hour algorithms for rapid triage of acute myocardial infarction. An international collaborative meta-analysis. Ann Intern Med. 2022;175:101-13. doi:10.7326/M21-1499 Google Scholar3. Lopez-Ayala P, Nestelberger T, Boeddinghaus J, et al; APACE and TRAPID-AMI Investigators. Novel criteria for the observe-zone of the ESC 0/1h-hs-cTnT algorithm. Circulation. 2021;144:773-787. [PMID: 34376064] doi:10.1161/CIRCULATIONAHA.120.052982 CrossrefMedlineGoogle Scholar4. Gray AJ, Roobottom C, Smith JE, et al; RAPID-CTCA Investigators. Early computed tomography coronary angiography in patients with suspected acute coronary syndrome: randomised controlled trial. BMJ. 2021;374:n2106. [PMID: 34588162] doi:10.1136/bmj.n2106 CrossrefMedlineGoogle Scholar5. Lee KK, Bularga A, O’Brien R, et al. Troponin-guided coronary computed tomographic angiography after exclusion of myocardial infarction. J Am Coll Cardiol. 2021;78:1407-1417. [PMID: 34593122] doi:10.1016/j.jacc.2021.07.055 CrossrefMedlineGoogle Scholar6. Probst MA, Noseworthy PA, Brito JP, et al. Shared decision-making as the future of emergency cardiology. Can J Cardiol. 2018;34:117-124. [PMID: 29289400] doi:10.1016/j.cjca.2017.09.014 CrossrefMedlineGoogle Scholar7. Jenniskens K, de Groot, Reitsma JB, et al. Overdiagnosis across medical disciplines: a scoping review. BMJ Open. 2017;7:e018448. [PMID: 29284720] doi:10.1136/bmjopen-2017-018448 CrossrefMedlineGoogle Scholar8. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:e596-e646. [PMID: 30879355] doi:10.1161/CIR.0000000000000678 CrossrefMedlineGoogle Scholar9. Smith SC Jr, Benjamin EJ, Bonow RO, et al; World Heart Federation and the Preventive Cardiovascular Nurses Association. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from The American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124:2458-73. [PMID: 22052934] doi:10.1161/CIR.0b013e318235eb4d CrossrefMedlineGoogle Scholar10. Hendley NW, Moskop J, Ashburn NP, et al. The ethical dilemma of emergency department patients with low-risk chest pain. Emerg Med J. 2021;38:851-854. [PMID: 33687992] doi:10.1136/emermed-2020-209900 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Departments of Emergency Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, CanadaCumming School of Medicine, University of Calgary, Calgary, Alberta, CanadaDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-4342.Corresponding Author: Andrew D. McRae, MD, PhD, Departments of Emergency Medicine and Community Health Sciences, Room C231, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB, Canada T2N2T9; e-mail, [email protected]ca.This article was published at Annals.org on 23 November 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPerformance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction Cho-Han Chiang , Cho-Hung Chiang , John W. Pickering , Kiril M. Stoyanov , Derek P. Chew , Johannes T. Neumann , Francisco Ojeda , Nils A. Sörensen , Ke-Ying Su , Peter Kavsak , Andrew Worster , Kenji Inoue , Tonje R. Johannessen , Dan Atar , Michael Amann , Willibald Hochholzer , Arash Mokhtari , Ulf Ekelund , Raphael Twerenbold , Christian Mueller , Philipp Bahrmann , Nicolas Buttinger , Maureen Dooley , Onlak Ruangsomboon , Richard M. Nowak , Christopher R. DeFilippi , William F. Peacock , Tomas G. Neilan , Michael A. Liu , Wan-Ting Hsu , Gin Hoong Lee , Pui-Un Tang , Kevin Sheng-Kai Ma , Dirk Westermann , Stefan Blankenberg , Evangelos Giannitsis , Martin P. Than , and Chien-Chang Lee Metrics Cited byOutcomes in emergency department patients with intermediate elevations in high-sensitive cardiac troponin T January 2022Volume 175, Issue 1Page: 137-138KeywordsHigh sensitivity cardiac troponinIschemiaMyocardial infarctionTroponin ePublished: 23 November 2021 Issue Published: January 2022 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...