Dear Gentle readers,
Unfortunately (but not strangely) not all have to use troponins for
assessment of chest pain on a regular basis so would like to pass by these
topics (EG paediatric A&E!) -so please include a title in the subject
section
Thank you for your kindness and long may the discussions about MI flourish!


-----Original Message-----
From: Rowley Cottingham
To: [log in to unmask]
Sent: 18/10/2002 17:19

Troponins do not rise for 2 to 3 hours after infarction, and a single
troponin is very unreliable. Two, 6 to 12 hours apart is more useful. I
am more concerned by the Edinburgh paper (Ferguson, Beckett, Stoddart,
Walker Fox; Myocardial infarction redefined: the new ACC/ESC definition,
based on cardiac troponin, increases the apparent incidence of
myocardial infarction. Heart 2002;88:343-7) in which they show that
patients with dubious chest pain (i.e not barn door ECG) are more likely
to be diagnosed with an MI if troponins are measured than "conventional"
CK/CK-MB. 40% vs 29%. They note dryly that the implications are
substantial.

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Jason Kendall
Sent: 17 October 2002 20:52
To: [log in to unmask]
Subject:


This paper (and 2 others published in 2001 from North America) has a
major problem with applicability to the UK population; median pain to
presentation times were 4 - 6 hours. This is NOT the experience in the
UK, where median times are generally much shorter; our median pain to
needle times (i.e pain to presentation plus DTN) in an urban / sub-urban
environment are 2-2.5 hours. The aggressive point of care 90 minute
rule-out strategy porposed may be suitable for the population studied in
the papers, but I would be very concerned about adopting it in our
population. Also of note in these papers is the very low incidence of
"cardiac" pain in their "chest pain" protocol; we have a much higher
incidence of cardiac pain in our population in whom we are risk
stratifying using troponins.

Therefore, the population studied in these papers is different in both
prevelance of underlying disease and timing of presentation, and
generalisability of findings to our population is poor.

Jason Kendall.
North Bristol NHS Trust.

"Brown, Ruth" wrote:

> A question about the use of Troponins
> Has anyone taken up the protocol suggested by Ng (Ng Siu Ming-AmJ
> Cardiol 2001 88-661-617 Pathway for Chest P.doc) where they suggest
> that troponins at 90 minutes will help send chest pains home safely.
> Our cardiologists are very sceptical on the basis that very few
> patients were included in whom it wasn't already clear it was not
> cardiac and the ones that troponin was used on were very few. However,

> our Public Health colleagues are pressing us to use this, via our
> Chief Exec to solve the 4 hour problem!!!  Any comments? I have a
> scanned version of the paper if anyone wants it but very large so
> contact off list. thanks Ruth
>
> Ruth Brown
> Consultant in Emergency Medicine
> 0207 886 6574