Delta troponin for the early diagnosis of AMI in emergency patients with chest pain: Commentary

A/Prof Louise Cullen writes…

The minefield of differences in troponin assays confuses clinicians, in an area of medicine that is already complex. Determining which patients presenting to Emergency Departments (EDs) with symptoms of possible Acute Coronary Syndromes actually have this underlying diagnosis is challenging. Current guidelines recommend lengthy assessment processes generally not achievable in acceptable time frames for patients to remain in the ED, and thus encourage Emergency Physicians to admit ‘all’ who present with possible symptoms of ACS.

Add to this mix the variability in analytical characteristics between troponin assays and information on change values (deltas) and it seems to many clinicians that this is simply getting too tough.

Our latest paper ‘Delta troponin for the early diagnosis of AMI in emergency patients with chest pain’ in the International Journal of Cardiology highlights how early (0 and 2hr post ED presentation) troponin values may be used to identify those with and without AMI using a sensitive troponin I assay. The concept of an algorithm suggesting a ‘rule-in AMI’, ‘rule-out AMI’ and ‘observation group’ at a very early time point after presentation in patients with suspected AMI has been advocated by others, including Prof Christian Mueller’s research group,  who have reported this sort of pathway with other troponin assays. These efforts are to simplify the approach to troponin testing, but remain assay-specific in the details, and hence we need this information for many more assays in clinical use.

Ultimately there is still more we need to understand, particularly in how best we utilise the next, more precise generation of troponin assays (aka high-sensitivity assays). More to come soon…