I Casagranda1, E C Lauritano. 1. Emergency Department, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy. icasagranda@ospedale.al.it
Abstract
BACKGROUND AND OBJECTIVES: Chest pain is one of the most frequent presenting complaints among patients arriving to the Emergency Department. In this population, the prevalence of acute coronary syndrome is about 25% instead that of acute myocardial infarction ranges from 5 to 15%. The diagnostic challenge for the emergency physician is the early rule-in or rule out of acute myocardial infarction within first few hours after chest pain presentation, particularly in those patients with normal or not significant electrocardiogram. EVIDENCE AND INFORMATION SOURCES: The current review is based on an analysis of most important clinical trials on this topic. STATE OF THE ART: The universal current guidelines established that the term "myocardial infarction" should be used when there is evidence of myocardial necrosis of ischemic origin, as documented by an increase of myocardial necrosis markers. Actually, cardiac troponins are considered the standard biomarkers for acute myocardial infarction diagnosis, because are more superior in sensitivity and specificity to the other available markers. PERSPECTIVES: More recently, high sensitive troponin assays have been developed, permitting the early measurement of very low concentrations. CONCLUSION: In this review, we analyzed the diagnostic and prognostic significance of these new high sensitive troponins in Emergency Department chest pain management.
BACKGROUND AND OBJECTIVES:Chest pain is one of the most frequent presenting complaints among patients arriving to the Emergency Department. In this population, the prevalence of acute coronary syndrome is about 25% instead that of acute myocardial infarction ranges from 5 to 15%. The diagnostic challenge for the emergency physician is the early rule-in or rule out of acute myocardial infarction within first few hours after chest pain presentation, particularly in those patients with normal or not significant electrocardiogram. EVIDENCE AND INFORMATION SOURCES: The current review is based on an analysis of most important clinical trials on this topic. STATE OF THE ART: The universal current guidelines established that the term "myocardial infarction" should be used when there is evidence of myocardial necrosis of ischemic origin, as documented by an increase of myocardial necrosis markers. Actually, cardiac troponins are considered the standard biomarkers for acute myocardial infarction diagnosis, because are more superior in sensitivity and specificity to the other available markers. PERSPECTIVES: More recently, high sensitive troponin assays have been developed, permitting the early measurement of very low concentrations. CONCLUSION: In this review, we analyzed the diagnostic and prognostic significance of these new high sensitive troponins in Emergency Department chest pain management.