the things nobody told you about troponin
Post on 27-Jan-2017
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Universal definition
What you don’t know
• What difference does the assay make?• Why does hs-troponin allow earlier rule out?
Patient arrivesin the ED: T0
Blood taken30-45 min
ECG10 min
Triage15 min
3h test3h 30 - 3h 45
Result 12h 30
Result 2:5h 30 - 5h 45
4h
Wh y a 3h Te s t Do esn ’ t Redu ce
Admi s s i o n s
THE BEST STUDY
10ng/L
4th Generation troponin T
High sensitivity
3ng/L 5ng/L 14ng/L
ABNORMAL
ABNORMAL
95% CI 96.7 - 99.9%
95% CI 98.5 - 100.0%
ONE-HOUR RULE OUT1,282 patients
0h <12ng/L ANDDelta <3ng/L
63.4% ruled outNPV 99.1%
0h >51ng/LOR delta >4ng/L
14.4% ruled inPPV 77.2%
Others
22.2% patients22.5% had AMI
Sensitivity 96.7%Mueller et al, ESC 2014
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