Rapid rule-out of acute myocardial infarction: understanding cardiac troponin

This is a talk I gave at the Saudi Arabian Society for Emergency Medicine (SASEM) conference in February 2022. In it, I discuss the latest evidence for rapid rule-out of acute myocardial infarction in the Emergency Department. I discuss the use of high-sensitivity cardiac troponin with the 'limit of detection' rule-out strategy and the 0/1-hour pathway. I then discuss the use of decision aids such as the HEART score and the Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid. There's some discussion of point of care testing and future possibilities as well. I hope you enjoy!

[@jasonhernandez7573]

Is 0.05 normal? Please help

[@massivecumshot]

My cardiologist tells me .04 ng/ml is the MI line.

[@RichardBody]

It depends on the ‘assay’ (or the brand of test) that’s being used. You’d need to know that in order to interpret whether the test result is normal. The normal range is set by running a study with healthy volunteers (at least 300 men and at least 300 women). You set the limit so that 99% of the healthy people have a level below that limit. This is called the 99th percentile. The 99th percentile can vary - for one test it’s 0.014ng/ml (14ng/L), whereas for another test the upper limit for men is 54ng/L (0.054ng/ml). So it all depends on the particular assay that was used.

[@adamccray-ikem8973]

You hijacked my phone