CHAPTER 18 TROPONINS IN CHEST PAIN

Emergency Room Triage of Patients with Acute Chest Pain by Means of Rapid Testing for Cardiac Troponin T or Troponin I

Hamm CW, Goldmann BU, Heeschen C, et al. N Engl J Med. 1997;337:1648–1653

BACKGROUND

Acute chest pain is one of the most common reasons for ED presentation and has been the subject of decades of research to identify efficient approaches to diagnosing acute MI. As chest pain can be caused by a spectrum of disease from benign muscular strain to fatal acute coronary syndrome (ACS), it is a diagnostic challenge with medicolegal risk, morbidity, and mortality. Prior to this study patients with indeterminate EKGs occupied expensive beds in coronary care units while CK and CK-MB were measured over time, but these markers were nonspecific and had questionable prognostic value and poor specificity.

OBJECTIVES

To compare the efficacy of cardiac biomarkers—troponins T and I—in the ED evaluation and treatment of acute chest pain.

METHODS

A prospective trial at the University Hospital in Hamburg, Germany between June 1994 and March 1996.

Patients

Seven hundred and seventy-three consecutive patients of all ages who had acute anterior, precordial or left-sided chest pain lasting 12 hours or less unexplained by obvious local trauma and/or abnormalities on chest x-ray. Select exclusion criteria: ST segment elevations or documented acute MI during the preceding 2 weeks.

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