Using High-Sensitivity Cardiac Troponin T for Acute Cardiac Care.
Am J Med. 2017 Aug 23;:
Authors: Sandoval Y, Jaffe AS
Abstract
The recent approval of the 5(th) generation cTnT assay which has characteristics clinically of a high sensitivity assay has led to concern that the problems of increased sensitivity will be greater than the benefits. This will not be the case if Cardiology, Emergency Medicine and Laboratory Medicine combine to develop procedures for use of the assay. We advocate sex specific 99(th)% upper reference limit (URL) values of 15ng/L for men and 10ng/L for women. We suggest a 2 hour rule out strategy including a value less than the 99(th)% URL and the lack of a change in values of <4 ng/L. Those with values > 100 ng/L and or a changing pattern of values ≥10 ng/L are a population much more likely to have acute myocardial infarction. Most of the increment in elevated values will occur not in those with acute coronary problems but in those with primary cardiac disease like heart failure and those with primary non cardiac problems. The former belong on a cardiac service as they are at high risk. The latter should have therapy on the service most apt to provide optimally care for their primary diagnosis with cardiac consultation as needed.
PMID: 28843652 [PubMed - as supplied by publisher]