Troponin Test May Allow Rapid MI Rule-Out in the Emergency Department

(Arch Intern Med. Published online August 13, 2012. doi:10.1001/archinternmed.2012.3698.)

Editor’s Note: Authors disclosed financial support. The study was supported by research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, Abbott, Roche, [entity display=”Siemens” type=”organization” subtype=”company” active=”true” key=”siemens” ticker=”SI” exchange=”Xetra” natural_id=”fred/company/3916″]Siemens[/entity] and the Department of Internal Medicine, University Hospital Basel. The high-sensitivity cardiac troponin T assay was donated by Roche. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Commentary: Ruling Out Heart Attacks in the Emergency Department

In a commentary, L. Kristin Newby, M.D., M.H.S., of [entity display=”Duke University” type=”organization” subtype=”college” active=”true” key=”duke-university” natural_id=”fred/college/41″]Duke University[/entity] Medical Center, [entity display=”Durham” type=”place” active=”true” key=”nc/durham” natural_id=”places/20500″]Durham[/entity], N.C., writes: “With increasing ED [emergency department] overcrowding, more effective tools are needed to enable rapid triage of patients with possible MI [acute myocardial infarction].”

“With this study, Reichlin et al provide an important step forward in application of hsTn [high-sensitivity troponin] as a tool for triage of ED patients with possible MI. However much work remains to develop the evidence to bring hsTn testing and the algorithms they have developed to use in clinical practice,” Newby continues.

“Finally, although touted as ‘simple’ by the authors, the need for multicomponent algorithms that are different for rule-in and rule-out and that vary by age group or other parameters will challenge application by busy clinicians unlikely to remember or accurately process the proposed algorithm. As such, it will imperative that hsTn algorithms, if validated, are built into clinical decision support layered onto electronic health records so that testing results are provided electronically to physicians along with the algorithmic interpretation to allow systematic application in triage and treatment,” Newby concludes.

(Arch Intern Med. Published online August 13, 2012. doi:10.1001/archinternmed.2012.1808)

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