CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

December 3rd, 2009

Sensitive Troponin Assay: Who Needs It? Not Me!

Sensitive assays for troponin (see here and here) improve early diagnosis of acute myocardial infarction and risk stratification.  However, according to a recent NEJM study, sensitive assays detect low circulating levels of cardiac troponin in the great majority (98%) of patients who have stable coronary artery disease and preserved LV systolic function.
 
In many emergency departments, serum troponin levels are part of the routine “screening labs.” Not uncommonly, elevated levels are found in patients without ACS, which leads to unnecessary admissions, cardiac evaluations, and procedures. Indiscriminant use of sensitive assays for troponin will only exacerbate this problem.
 
Do I really need (or want) access to a more sensitive assay for troponin?  I’m not convinced. It may be more harmful than helpful to the patient and physician.

Categories: General


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One Response to “Sensitive Troponin Assay: Who Needs It? Not Me!”

  1. Audrey Sernyak, MD says:
    December 8, 2009 at 3:45 pm

    not me either

    The assay sensitivity at its current level aready adds to confusion over how to CLINICALLY manage a patent with CAD- it leads to a knee jerk reaction of cath rather than appropriate proven medical therapy as a first step. In addition it leads to confusion for the patients labeled as having an “MI”. Picking up more not less patients will only exacerbate this problem.