Is there not evidence that Troponin I is a better early marker? We've been
trying out a benchtop system (Biosyte TriageMeter) which does CK-MB, Trop I
and Myoglobin quantitatively in ten minutes and seems to be pretty good at
early detection of ischaemic events. Has anyone else any experience with
this machine?
Rocky
----- Original Message -----
From: eworthington <[log in to unmask]>
To: Acad-ae-med (E-mail) <[log in to unmask]>
Sent: Saturday, December 11, 1999 1:54 PM
Subject: Troponin T in A&E
> In response to the current flurry on troponins:
>
> The Royal Liverpool University Hospital has been using troponin T as its
> single cardiac marker since August 1998. The only indication for CK-MB is
a
> patient with a known infarct (tropT>0.2) who has ?re-infarcted within 14
> days, then a CK-MBmass is measured.
>
> Troponin T is measured at 12 hours post-onset of chest pain or 12 hours
> post-arrival if the onset time is uncertain. Time of onset of pain has to
be
> confirmed on the form and the lab won't measure it any earlier nor twice
on
> any one patient admission unless discussed with them (to try and minimize
> the serial measurers!).
> Patients with non-acute ECG (on admission and after 1 hour),
> haemodynamically stable, no pulmonary oedema, etc who are then pain free
can
> be admitted to the Obs ward for observation until their tropT is due. At
12
> hours they have a further ECG and review by A&E senior. If all is OK then
> are then discharged to their GP with a pre-printed letter and some GTN
spray
> if necessary. No ETT are done in A&E.
> All borderline trop T (0.1-0.2) are referred medically who then arrange
> urgent out-patient ETT for appropriate patients (usually within a week).
> When we set up this policy it was decided that the numbers of patients to
be
> sent home from A&E were too large and resources too limited for exercising
> everyone before discharge.
>
> We now have 15 months of experience with Troponin T in this way and have
had
> very few difficulties. We've also surprisingly enough made huge savings on
> our lab expenses due to the vastly overused CK measurement prior to this.
>
> Elspeth Worthington
> SpR Mersey Region
>
>
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