High-sensitivity troponin assays in the evaluation of patients with acute chest pain in the emergency department

Abstract

Evaluating patients with acute chest pain presenting to the emergency department remains an ongoing challenge. The spectrum of etiologies in acute chest pain ranges from minor disease entities to life-threatening diseases, such as pulmonary embolism, acute aortic dissection or acute myocardial infarction (MI). The diagnosis of acute MI is usually made integrating the triad of patient history and clinical presentation, readings of 12-lead ECG and measurement of cardiac troponins (cTn). Introduction of high-sensitivity cTn assays substantially increases sensitivity to identify patients with acute MI even at the time of presentation to the emergency department at the cost of specificity. However, the proportion of patients presenting with cTn positive, non-vascular cardiac chest pain triples with the implementation of new sensitive cTn assays increasing the difficulty for the emergency physician to identify those patients who are at need for invasive diagnostics. The main objectives of this mini-review are 1) to discuss elements of disposition decision made by the emergency physician for the evaluation of chest pain patients, 2) to summarize recent advances in assay technology and relate these findings into the clinical context, and 3) to discuss possible consequences for the clinical work and suggest an algorithm for the clinical evaluation of chest pain patients in the emergency department.

The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure

“…According to this defi nition, biomarkers are now used in a kaleidoscope of clinical conditions in the ED, including diagnosis (29) and prognostic assessment (30) of acute myocardial infarction, diagnosis of acute renal injury (31) , acute pancreatitis (32) , pre-eclampsia (33) , stroke (34) , CHF assessment (35) and AHF (Table 1 ).…”

High-sensitivity cardiac troponin I in the general population – defining reference populations for the determination of the 99th percentile in the Gutenberg Health Study

“…Sensitive troponin assays have facilitated confirmation and early exclusion of this diagnosis [2][3][4][5][6]. Beyond their use in suspected acute coronary syndrome (ACS) patients, the advent of novel, high-sensitivity troponin assays, which enable robust detection of very low troponin concentrations, opened the avenue for risk stratification in secondary prevention [7][8][9] and even the general population [9][10][11][12][13][14].…”

Ischemic heart disease in the emergency room: state of the art, innovation and research

“…18 It is noteworthy, however, that neither the sensitivity nor the negative predictive value of HS immunoassays achieve a value of 100% in samples collected on ED admission, so that the search for diagnostic algorithms combining troponin(s) with early biomarkers may still be seen as an appealing perspective. 19 A variety of tests have been proposed over the past decades for the diagnostic approach of IHD, either alone or in combination with troponin. 20 These mostly -but not exclusively -include inflammatory mediators or reactants (i.e.…”