Emergency Medicine Reports – August 25, 2013
August 25, 2013
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Evaluation of Acute Chest Pain: An Update on Potential Future Options
High-sensitivity cardiac troponin (hs-cTn) assays have higher sensitivity for myocardial ischemic injury and necrosis than conventional assays, but with reduced specificity. An hs-cTn level below the detectable limit is very accurate at excluding AMI in an ED patient with chest pain. The precision of hs-cTn assays enables serial sampling of cardiac biomarkers to exclude AMI to be done over 1-2 hours as opposed to 3-9 hours for conventional cTn assays. A normal coronary CT angiography (CCTA) (< 50% stenosis in any epicardial coronary artery) performed in an ED patient with chest pain is associated with a good 30-day outcome. Use of CCTA in ED patients with chest pain is associated with reduced length of stay, admissions, and overall costs compared to typical care that often involves myocardial perfusion imaging. CCTA is associated with a small but consistent increase in invasive coronary angiograms and reperfusion procedures compared to typical care that often involved myocardial perfusion imaging.