In this era of emergency practice a bulk of patient present to the ED with chest pain and exclusion of cardiac chest pain and/or ACS is one of the primary goals here.
Checking repeated cardiac troponin is a standard process and an acceptable way of management for suspected ACS patients. In our today’s discussion we aren’t going to discuss this regular practice and interpretation.
Rather, Here we are going to see when it’s safe to discharge a patient with only single high sensitive cardiac troponin T estimation.
As per the European society of cardiology guideline 2015, AMI can be ruled out if the high sensitivity troponin level is 3 hours has elapsed between onset of chest pain and blood sampling.
A recent meta analysis has supported the above mentioned statement.
Undetectable High-Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction is another good read supporting the above mentioned statement.
So in short – If first high sensitive Troponin T is less than 5ng/L (after 3 hours of onset of chest pain) and no ischemic ECG change noted in ECG – AMI can be ruled out and patient can be safely discharge with safety and further follow up in either community or hospital (if needed).
Thank you very much.