Updating an institutional chest pain algorithm

Obviously, the medical consequences of cardiomyocyte injury as quantified by c Tn elevations will be highly individualized and different from that in patients with MI.There are some rare circumstances when high or even very high c Tn concentrations are observed in the absence of myocardial injury, for example due to analytical assay interferences.Absolute rather than relative hs-c Tn changes seem to be the best metric to differentiate MI from other causes of chest pain.

Since the clinical assessment and electrocardiogram (ECG) alone are not sufficient to diagnose or exclude non-ST-segment elevation myocardial infarction (NSTEMI) in most patients, the addition of blood tests to measure the concentration of cardiac troponin (c Tn) T or I form the cornerstone for the early diagnosis of MI.If no cause of myocardial injury can be detected by imaging and further serial c Tn measurements remain in the normal range, the c Tn result suspected to be false-positive can most probably be explained to be a non-repeatable outlier.Second, if no c Tn change after retesting can be observed, c Tn should be measured using an alternative c Tn assay (if available).In cases of striking discordance between c Tn measurements and clinical presentation, analytical ‘false-positive’ test results (e.g.due to heterophilic antibodies) must be considered.

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