High-Sensitivity Troponin is not a Myth, and “Myth-busting” is often another Myth to be Busted

Conclusion: Early rule out protocol is effective and safe.We refer interested readers to the following excellent reviews of high-sensitivity troponin implementation:Twerenbold, R. et al.JACC70 (8): 996 –1012.https://doi.org/10.1016/j.jacc.2017.07.718.Yader S. et al. 2016. Am J Med 129 (4): 354 –65.https://doi.org/10.1016/j.amjmed.2015.12.005.Response to the 2nd “Myth-busting” articleInterestingly, on Nov 5, Dr. Spiegel publishedanother “Myths in EM” piece in EM News: “Is hs-cTnT Worth the Downstream Testing?. The piece assesses a new randomized trial of the Roche hs -cTnT (not the Abbott Troponin I, which is what was studied in the above Lancet study). [Here is the full text of this randomized trial:A Randomized Trial of a 1-Hour Troponin T Protocol in Suspected Acute Coronary Syndromes.]   Spiegel ’s piece starts by conceding that “hs assays....will soon replace the 4th generation assays currently being used.” This hs-cTnT study randomized potential ACS workups to a 0/1 hour hs-cTnT protocol vs. standard care. In the standard care arm, 0/3 hour troponins were used and the providers were blinded to any value less than 29 ng/L (the rationale for hs-cTn is to be able to precisely measure such small quantities, so this study was testing thevalue of knowing, vs. not knowing, the precise value of all such low troponin measurements). The study showed that more patients are discharged (45.1% vs. 32.3%), and discharged ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs