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CJEM Debate Series: #TropandGo – Negative high sensitivity troponin testing is safe as a final test for most emergency department patients with chest pain

  • Andrew D. McRae (a1), James E. Andruchow (a1), Frank X. Scheuermeyer (a2) (a3), Jim Christenson (a2) (a3) and Paul Atkinson (a4) (a5)...
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      CJEM Debate Series: #TropandGo – Negative high sensitivity troponin testing is safe as a final test for most emergency department patients with chest pain
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      CJEM Debate Series: #TropandGo – Negative high sensitivity troponin testing is safe as a final test for most emergency department patients with chest pain
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Corresponding author

Correspondence to: Dr. Andrew McRae, Department of Emergency Medicine, Rm C231, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB T2N 0K8; Email: amcrae@ucalgary.ca

References

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1.Christenson, J, Innes, G, McKnight, D, et al. Safety and efficiency of emergency department assessment of chest discomfort. CMAJ 2004;170:1803–7.
2.Morgenstern, J. “Stress tests part 1: How often do we miss MI?” First10EM blog, March 12, 2019. Available at: https://first10em.com/mi-miss-rate/ (accessed June 28, 2019).
3.Stopyra, JP, Riley, RF, Hiestand, BC, et al. The HEART pathway randomized 76 controlled trial one year outcomes. Acad Emerg Med 2018;26:4150.
4.Hollander, JE, Than, M, Mueller, C.State-of-the-art evaluation of emergency department patients presenting with potential acute coronary syndromes. Circulation 2016;134(7):547–64.
5.Foy, AJ, Liu, G, Davidson, WR, et al. Comparative effectiveness of diagnostic testing strategies in emergency department patients with chest pain: an analysis of downstream testing, interventions, and outcomes. JAMA Intern Med 2015;175(3):428–36.
6.MacGougan, CK, Christenson, J, Innes, G, Raboud, J.Emergency physicians’ attitudes toward a clinical prediction rule for the identification and early discharge of low risk patients with chest discomfort. CJEM 2001;3:8994.
7.Kline, JA, Johnson, CL, Pollack, CV Jr, et al. Pretest probability assessment derived from attribute matching. BMC Med Inform Decis Mak 2005;5:26.
8.Pickering, JQ, Than, MP, Cullen, L, et al. Rapid rule-out of acute myocardial infarction with a single high-sensitivity cardiac troponin T measurement below the limit of detection: a collaborative meta-analysis. Ann Intern Med 2017;166:715–24.
9.Mokhtari, A, Lindahl, B, Schiopu, A, et al. A 0-hour/1-hour protocol for safe, early discharge of chest pain patients. Acad Emerg Med 2017;24:983–92.
10.Andruchow, JE, Kavsak, P, McRae, AD.Contemporary emergency department management of patients with chest pain: a concise review and guide for the high-sensitivity troponin era. Can J Cardiol 2018;34(2):98108.
11.Amsterdam, EA, Wenger, NK, Brindle, RG, et al. 2014 AHA/ACC guidelines for the management of patients with non-ST-elevation acute coronary syndromes. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;130:e346-e423.
12.Hollander, JE.High sensitivity troponin: time to implement. Ann Emerg Med 2018;72:665–7.
13.Mueller, C, Giannitsis, M, Christ, M, et al. Multicenter evaluation of a 0-hour/1-hour algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin. T. Ann Emerg Med 2016;68:6787.
14.Backus, BE, Six, AJ, Kelder, JC, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol 2013;168:21532158.
15.Scheuermeyer, FX, Innes, G, Grafstein, E, et al. Safety and efficiency of a chest pain diagnostic algorithm with selective outpatient stress testing for emergency department patients with potential ischemic chest pain. Ann Emerg Med 2012;59:256–64.e3.
16.Greenslade, JH, Parsonage, W, Than, M, et al. A clinical decision rule to identify emergency department patients at low risk for acute coronary syndrome who do not need objective coronary artery disease testing: the no objective testing rule. Ann Emerg Med 2016;67:478–89.e2.
17.Scheuermeyer, FX, Wong, H, Yu, E, et al. Development and validation of a prediction rule for early discharge of low-risk emergency department patients with potential ischemic chest pain. CJEM 2014;16:106–19.
18.Shah, AS, Anand, A, Strachan, FE, et al. High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomized trial. Lancet 2018;392:919–28.
19.Hollander, JE, Blomkalns, A, Brogan, GX, et al. Standardized reporting guidelines for studies evaluating risk stratification of emergency department patients with potential acute coronary syndromes. Ann Emerg Med 2004;44:589–98.
20.Hess, EP, Hollander, JE, Schaffer, JT, et al. Shared decision making in patients with low-risk chest pain: prospective randomized pragmatic trial. BMJ 2016;355:i6165.

Keywords

CJEM Debate Series: #TropandGo – Negative high sensitivity troponin testing is safe as a final test for most emergency department patients with chest pain

  • Andrew D. McRae (a1), James E. Andruchow (a1), Frank X. Scheuermeyer (a2) (a3), Jim Christenson (a2) (a3) and Paul Atkinson (a4) (a5)...

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