high sensitivity troponin: friend or foe?
DESCRIPTION
Louise Cullen and Rick Body fuel a contentious debate on the clinical significance of the high sensitivity troponin assay. Will your patients benefit from that extra digit ?TRANSCRIPT
![Page 1: High Sensitivity Troponin: Friend or Foe?](https://reader033.vdocuments.us/reader033/viewer/2022052822/554ae60ab4c905852a8b4c08/html5/thumbnails/1.jpg)
HIGH SENSITIVITY TROPONIN IN THE EMERGENCY DEPARTMENT:
FRIEND OR FOE?Rick Body
![Page 2: High Sensitivity Troponin: Friend or Foe?](https://reader033.vdocuments.us/reader033/viewer/2022052822/554ae60ab4c905852a8b4c08/html5/thumbnails/2.jpg)
DISCLAIMERWhat I say is not necessarily my personal opinion.
COI: Expert adviser to NICE, active researcher in this area (including industry supported work)Image by RedHotHeat via Wikimedia Commons
![Page 3: High Sensitivity Troponin: Friend or Foe?](https://reader033.vdocuments.us/reader033/viewer/2022052822/554ae60ab4c905852a8b4c08/html5/thumbnails/3.jpg)
HIGH SENSITIVITY TROPONIN READS HIGHERSo you get more positives
10ng/L
Standard troponin
HS-troponin
35ng/L14ng/L
![Page 4: High Sensitivity Troponin: Friend or Foe?](https://reader033.vdocuments.us/reader033/viewer/2022052822/554ae60ab4c905852a8b4c08/html5/thumbnails/4.jpg)
Chest pain
Collapse
SOB
"Unwell"
0 17.5 35 52.5 70
34.4
68.4
36.5
20.4
12.2
19.8
11.1
10.5
Before hs-Tn After hs-Tn
0
20
40
60
80
All Age >75
74
32 3018
Before hs-Tn After hs-Tn
Proportion of positive results before & after introducing hs-cTnT
![Page 5: High Sensitivity Troponin: Friend or Foe?](https://reader033.vdocuments.us/reader033/viewer/2022052822/554ae60ab4c905852a8b4c08/html5/thumbnails/5.jpg)
ANSWER: 50%
If your patient with suspected ACS has a positive troponin, what is the overall
probability that they have AMI?
Image by anieto2k on Flickr..comBody et al, JACC 2011; 58: 1332-9
![Page 6: High Sensitivity Troponin: Friend or Foe?](https://reader033.vdocuments.us/reader033/viewer/2022052822/554ae60ab4c905852a8b4c08/html5/thumbnails/6.jpg)
WHY DO WE NEED A HIGH SENSITIVITY ASSAY?
![Page 7: High Sensitivity Troponin: Friend or Foe?](https://reader033.vdocuments.us/reader033/viewer/2022052822/554ae60ab4c905852a8b4c08/html5/thumbnails/7.jpg)
SO WE CAN SEE LEVELS IN NORMAL PEOPLE
Because that's so helpful in practice, right?
![Page 8: High Sensitivity Troponin: Friend or Foe?](https://reader033.vdocuments.us/reader033/viewer/2022052822/554ae60ab4c905852a8b4c08/html5/thumbnails/8.jpg)
2. BECAUSE THE RESULTS ARE MORE
PRECISEWith a 25% CV instead of 10%:
An extra 0.3% of patients will have a false positive result after 2 tests
!
"We believe that the clinical implications of this false positive frequency are
insignificant"
Apple et al, Clin Chem 2005; 51:2198-2200
![Page 9: High Sensitivity Troponin: Friend or Foe?](https://reader033.vdocuments.us/reader033/viewer/2022052822/554ae60ab4c905852a8b4c08/html5/thumbnails/9.jpg)
WHAT’S THE EVIDENCE OF BENEFIT?
![Page 10: High Sensitivity Troponin: Friend or Foe?](https://reader033.vdocuments.us/reader033/viewer/2022052822/554ae60ab4c905852a8b4c08/html5/thumbnails/10.jpg)
![Page 11: High Sensitivity Troponin: Friend or Foe?](https://reader033.vdocuments.us/reader033/viewer/2022052822/554ae60ab4c905852a8b4c08/html5/thumbnails/11.jpg)
I REST MY CASE, M'LUDMay justice be done