You are here

Article Text

Article menu

Download PDFPDF

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

    http://dx.doi.org/10.1136/emj.17.3.213

    Statistics from Altmetric.com

      Request Permissions

      If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

      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.

      View this table:
      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

      1. Mair J, Smidt J, Lechleitner P, et al. Rapid accurate diagnosis of acute myocardial infarction in patients with non-traumatic chest pain within one hour of admission. Coron Artery Dis1995;6:539–45.
        OpenUrlPubMedWeb of Science
      2. De Winter RJ, Koster RW, Sturk A, et al. value of myoglobin, troponin T and CK-MB mass in ruling out acute myocardial infarction in the emergency department. Circulation1995;92:3401–7
        OpenUrlAbstract/FREE Full Text
      3. Tucker JF, Collins RA, Anderson AJ, et al. early diagnostic efficiency of cardiac troponin I and troponin T for acute myocardial infarction. Acad Emerg Med1997;4:13–21.
        OpenUrlPubMedWeb of Science
      4. REACTT investigators study group. Evaluation of a bedside whole blood rapid troponin T assay in the emergency department. Rapid evaluation by assay of cardiac troponin T (REACTT). Acad Emerg Med1997;4:1015–17.
        OpenUrlCrossRefPubMedWeb of Science
      5. Hamm CW, Goldman BU, Heeschen C, et al. Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or I. N Engl J Med1997;337:1648–53.
        OpenUrlCrossRefPubMedWeb of Science
      6. Moher ER 3rd, Ryan T, Segar DS, et al. Clinical utility of troponin T levels and electrocardiography in the Emergency Department. Am Heart J1998;135:253–60.
        OpenUrlCrossRefPubMedWeb of Science
      7. Sayre MR, Kaufmann KH, Chen I-W, et al. Measurement of cardiac troponin T is an effective method for predicting complications among emergency department patients with chest pain. Ann Emerg Med1998;31:539–49.
        OpenUrlCrossRefPubMedWeb of Science
      8. Zimmermman J, Fromm R, Meyer D, et al. Diagnostic marker co-operative study for the diagnosis of myocardial infarction. Circulation1999;99:1671–7.
        OpenUrlAbstract/FREE Full Text
      9. Johnson PA, Goldmman L, Sacks DB, et al. Troponin T as a marker for myocardial ischaemia in patients seen at the emergency department for acute chest pain. Am Heart J1999;137:1137–44.
        OpenUrlCrossRefPubMedWeb of Science