Updating an institutional chest pain algorithm

The following two-step approach may facilitate further clinical workup: first, c Tn retesting using the same c Tn assay should be performed.

In case of a relevant change, acute myocardial injury must be excluded by imaging or invasive strategy.

They ought to be interpreted as quantitative variables and not in a binary fashion (negative/positive) like a pregnancy test.

From a diagnostic perspective, it is highly inappropriate to label a patient as ‘c Tn-positive’, as this would lump together patients with only mildly elevated c Tn levels barely above the 99th percentile and an associated positive predictive value (PPV) for NSTEMI of only about 40–50% with patients with markedly elevated c Tn levels (e.g.

Continuous medical education and training of physicians in these concepts is essential to avoid inappropriate interpretation of chronic mild elevations of c Tn associated with e.g.Thereby, c Tn T and I are organ specific, but not disease-specific markers.High-sensitivity and sensitive c Tn T and I assays exactly quantify the amount of cardiomyocyte injury.about five times above the 99th percentile) and an associated PPV of 90%.The higher the c Tn level, the higher is the likelihood for the presence of MI.

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Obviously, the medical consequences of cardiomyocyte injury as quantified by c Tn elevations will be highly individualized and different from that in patients with MI.

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