PMID- 29695327
OWN - NLM
STAT- MEDLINE
DCOM- 20190503
LR  - 20190503
IS  - 1532-8171 (Electronic)
IS  - 0735-6757 (Linking)
VI  - 36
IP  - 6
DP  - 2018 Jun
TI  - High sensitivity troponin: The Sisyphean pursuit of zero percent miss rate for 
      acute coronary syndrome in the ED.
PG  - 1088-1097
LID - S0735-6757(18)30267-5 [pii]
LID - 10.1016/j.ajem.2018.03.075 [doi]
AB  - BACKGROUND: The United States Food and Drug Administration recently approved a 
      high sensitivity troponin (hsTn) assay for use. Recent literature has 
      investigated the diagnostic accuracy of hsTn for acute coronary syndrome (ACS) in 
      the emergency department (ED) and its use in accelerated diagnostic protocols. 
      OBJECTIVE: This article evaluates the existing literature and discusses 
      incorporation of hsTn testing into ED clinical practice based on best available 
      evidence. DISCUSSION: Interpretation of this literature for clinical application 
      is challenging due to heterogeneity across studies with regards to the hsTn 
      assays examined, time intervals for delta troponin tests, and study populations. 
      The high sensitivity of these assays is predicated upon the ability of the 
      physician to clinically determine a patient to have a low pre-test probability of 
      disease. Physicians may further ensure maximal sensitivity by defining the 
      cut-off for a positive value as the limit of detection and utilizing delta 
      troponin testing. These assays do not obviate the need to consider follow-up for 
      risk stratification for discharged patients. Higher sensitivity compared to 
      standard troponin tests comes at the expense of lower specificity. Indiscriminate 
      testing may translate to greater numbers of abnormal troponin results in patients 
      with non-ACS syndromes, potentially leading to increased healthcare costs, 
      hospital admissions, increased ED lengths of stay, and unnecessary interventions. 
      CONCLUSION: As hsTn becomes more widespread, it is imperative emergency 
      physicians understand its potential and limitations. Knowledge of test 
      characteristics is vital to ensure appropriate use. Further study of hsTn is 
      required to optimize use.
CI  - Published by Elsevier Inc.
FAU - Summers, Shane M
AU  - Summers SM
AD  - Department of Emergency Medicine, Brooke Army Medical Center, 3841 Roger Brooke 
      Dr, Fort Sam Houston, TX 78234, United States. Electronic address: 
      shane.m.summers.mil@mail.mil.
FAU - Long, Brit
AU  - Long B
AD  - Department of Emergency Medicine, Brooke Army Medical Center, 3841 Roger Brooke 
      Dr, Fort Sam Houston, TX 78234, United States. Electronic address: 
      brit.long@yahoo.com.
FAU - April, Michael D
AU  - April MD
AD  - Department of Emergency Medicine, Brooke Army Medical Center, 3841 Roger Brooke 
      Dr, Fort Sam Houston, TX 78234, United States. Electronic address: 
      michael.d.april.mil@mail.mil.
FAU - Koyfman, Alex
AU  - Koyfman A
AD  - Department of Emergency Medicine, The University of Texas Southwestern Medical 
      Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States.
FAU - Hunter, Curtis J
AU  - Hunter CJ
AD  - Department of Emergency Medicine, Brooke Army Medical Center, 3841 Roger Brooke 
      Dr, Fort Sam Houston, TX 78234, United States. Electronic address: 
      curtis.j.hunter.civ@mail.mil.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20180403
PL  - United States
TA  - Am J Emerg Med
JT  - The American journal of emergency medicine
JID - 8309942
RN  - 0 (Biomarkers)
RN  - 0 (Troponin)
SB  - IM
MH  - Acute Coronary Syndrome/blood/*diagnosis
MH  - Biomarkers/blood
MH  - *Emergency Service, Hospital
MH  - *Hospitalization
MH  - Humans
MH  - Reproducibility of Results
MH  - Triage/*methods
MH  - Troponin/*blood
OTO - NOTNLM
OT  - Acute coronary syndrome
OT  - Diagnostic accuracy
OT  - Emergency department
OT  - High sensitivity
OT  - Troponin
EDAT- 2018/04/27 06:00
MHDA- 2019/05/06 06:00
CRDT- 2018/04/27 06:00
PHST- 2018/02/22 00:00 [received]
PHST- 2018/03/22 00:00 [revised]
PHST- 2018/03/28 00:00 [accepted]
PHST- 2018/04/27 06:00 [pubmed]
PHST- 2019/05/06 06:00 [medline]
PHST- 2018/04/27 06:00 [entrez]
AID - S0735-6757(18)30267-5 [pii]
AID - 10.1016/j.ajem.2018.03.075 [doi]
PST - ppublish
SO  - Am J Emerg Med. 2018 Jun;36(6):1088-1097. doi: 10.1016/j.ajem.2018.03.075. Epub 
      2018 Apr 3.