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Troponin T to rule out myocardial damage in chest pain
  1. Katrina Richell-Herren,
  2. Sue Maurice
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL

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    Report by Katrina Richell-Herren, Research Fellow Search checked by Sue Maurice, Consultant

    Clinical scenario

    A 50 year old man attends the emergency department with a 12 hour history of chest pain that may be cardiac in origin. His ECG is normal. You want to rule out possible myocardial damage and wonder whether a single troponin T measurement taken at this time is sensitive enough to do this.

    Three part question

    In [patients with cardiac chest pain and a normal ECG] is [a single troponin T measurement] sensitive enough to [rule out myocardial damage in the first 12 hours]?

    Search strategy

    Medline 1966–01/00 using the OVID interface. ({exp diagnosis OR diagnosis.mp} AND troponin$.mp) LIMIT to human AND english.

    Search outcome

    Altogether 590 papers found of which 581 were irrelevant or of insufficient quality. The remaining nine papers are shown in table 2.

    Table 2

    Comments

    No study has systematically evaluated the point at which troponin T becomes sensitive enough to effectively rule out acute myocardial infarction in emergency department patients. No study has shown a high enough sensitivity (> 95%) to allow use as a SnNout at less than 12–24 hours.

    Clinical bottom line

    Troponin T is not sensitive enough to rule out myocardial damage in the first 12 hours after onset of chest pain.

    Report by Katrina Richell-Herren, Research Fellow Search checked by Sue Maurice, Consultant

    References

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