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Title: High sensitivity troponin: Does the 50% delta change alter clinical outcomes in chest pain presentations to the emergency room?
Austin Authors: Sajeev, Jithin K;New, Gishel;Roberts, Louise;Menon, Siddharth K;Gunawan, Florence;Wijesundera, Piyumi;Teh, Andrew W 
Affiliation: Monash University, Eastern Health Clinical School, Victoria, Australia
Cardiology Department, Austin Hospital, Heidelberg, Victoria, Australia
Issue Date: 27-Jan-2015
Publication information: International Journal of Cardiology 2015; 184(): 170-4
Abstract: The National Heart Foundation (NHF) and Cardiac Society of Australia and New Zealand (CSANZ) Acute Coronary Syndrome (ACS) guidelines recommend the use of a high sensitivity troponin assay (hsTrop) in the assessment of patients presenting with ACS. A troponin delta of 50% compared with the previously recommended 20% is advocated by the guidelines to aid in the clinical diagnosis of ACS. We sought to determine the clinical impact of the updated recommendation to use 50% troponin delta for patients presenting with chest pain to the emergency department.We retrospectively collected data for all patients >18years presenting with chest or abdominal pain with a hsTrop test performed between January-June 2012. Patients with a STEMI, lacked serial hsTrop, were on dialysis or had trauma-related pain were excluded.Of the 1054 eligible patients, 422 (40%) with serial hsTrop had at least one abnormal troponin (>14ng/ml). 73 (6.9%) fell within 20-50%. Twenty-seven had clinical or ECG evidence suggestive of ACS and were referred for further cardiac investigations. Of the remainder, five patients were medically managed for ACS, 38 patients with non-cardiac chest pain had no further tests. At 1year follow-up, of the patients that did not undergo further investigations, 6 patients represented with ACS; there was no cardiac mortality.Our data showed a number of patients that would be potentially missed with the implementation of a 50% troponin. However, this loss of sensitivity was mitigated by the use of clinical acumen.
Gov't Doc #: 25705009
DOI: 10.1016/j.ijcard.2015.01.074
Journal: International journal of cardiology
Type: Journal Article
Subjects: Acute coronary syndrome
High sensitivity
Myocardial infarction
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