High-Sensitivity Cardiac Troponin and the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guidelines for the Evaluation and Diagnosis of Acute Chest Pain.
Yader SandovalFred S AppleSimon A MahlerRichard BodyPaul O CollinsonAllan S Jaffenull nullPublished in: Circulation (2022)
The 2021 American Heart Association/American College of Cardiology/American Society of Echocardiography/American College of Chest Physicians/Society for Academic Emergency Medicine/Society of Cardiovascular Computed Tomography/Society for Cardiovascular Magnetic Resonance guidelines for the evaluation and diagnosis of acute chest pain make important recommendations that include the recognition of high-sensitivity cardiac troponin (hs-cTn) as the preferred biomarker, endorsement of 99th percentile upper reference limits to define myocardial injury, and the use of clinical decision pathways, as well as acknowledgment of the uniqueness of women and other patient subsets. Details on how to integrate hs-cTn into clinical practice are less extensively addressed. Clinicians should be aware of some of the analytical aspects related to hs-cTn assays regarding the limit of detection and the limit of quantitation and how they are used clinically, especially for the single sample strategy to rule out acute myocardial infarction. Likewise, it is important for clinicians to understand issues related to the derivation of the 99th percentile upper reference limit; the value of sex-specific 99th percentile upper reference limits; how to use changing concentrations (deltas) to facilitate diagnosis and risk stratification of patients with suspected acute coronary syndrome, including the differentiation of acute from chronic myocardial injury; and how to best integrate the use of hs-cTn with clinical decision pathways. With the use of hs-cTn, conditions such as type 2 myocardial infarction become more common, whereas others such as unstable angina become less frequent but still occur. Sections relating to these issues are included.
Keyphrases
- clinical practice
- liver failure
- computed tomography
- magnetic resonance
- respiratory failure
- acute coronary syndrome
- acute myocardial infarction
- drug induced
- left ventricular
- percutaneous coronary intervention
- aortic dissection
- emergency medicine
- heart failure
- palliative care
- primary care
- coronary artery
- coronary artery disease
- hepatitis b virus
- polycystic ovary syndrome
- ms ms
- extracorporeal membrane oxygenation
- pregnant women
- skeletal muscle
- insulin resistance
- metabolic syndrome
- case report
- atrial fibrillation
- label free
- intensive care unit
- high throughput
- acute kidney injury
- pulmonary hypertension
- breast cancer risk
- dual energy
- sensitive detection
- image quality