UCLA guidelines: TnI in chest pain protocol
UCLA guidelines: TnI in chest pain protocol
TnI elevates for 4-6 days post-AMI
Troponin I (TnI) was made a part of UCLA Medical Center's clinical practice guideline for chest pain evaluation because of its improved time-dependent sensitivity and specificity over creatine kinase-MB (CK-MB) in patients who present 48 hours to six days after infarction. (See diagnostic algorithms, inserted in this issue.)
The guideline states that chest pain patients without a diagnostic EKG who are TnI negative at eight hours, chest pain free, and without dynamic ischemia on EKG are good candidates for early stress testing. The patient may be discharged if the stress test in negative. TnI positive patients should undergo early catheterization.
TnI is typically elevated for four to six days post-AMI. Patients who present with chest pain more than 48 hours prior to admission may have sustained an AMI but would not be expected to have continued elevation in CK-MB.
The guideline contains the following caveat: A negative TnI assay does not exclude the diagnosis of unstable angina or AMI of less than seven hours duration. As with CK-MB, the assay should not be used to determine whether to admit or discharge a patient presenting to the ED with chest pain. Diagnosis, risk assessment, and the decision as to whether inpatient or outpatient management is indicated should be based on the history, physician examination, and EKG. Admission or referral should not be delayed to await the results of the TnI assay.
(Editor's note: Access http://www.cost-quality. com/2.3art.html on the Internet for an explanation of four clinical presentations in which the TnI assay should be considered for use.)
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.