08 Sep Despite Valuable Biomarkers Clinical Evaluation Still Important in Diagnosing Heart Attack

MedicalResearch.com Interview with:

Dr. Juan Sanchis

Dr. Juan Sanchis
Full professor of Medicine
Cardiology Department, University Clinic
Hospital. Medicine Department, University of Valencia
Valencia. Spain

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Decision making in acute chest pain in the emergency departments
remains challenging despite the introduction of new troponin assays
(high-sensitivity assays) capable of detecting any amount of
myocardial damage.

The upper limit of normality of high-sensitivity
troponin is established at the 99th percentile of a normal reference
population. This is the limit for the diagnosis of acute myocardial
infraction. Detectable troponin levels below the 99th percentile,
though non diagnostic of acute myocardial infarction, might be
considered as of uncertain significance since some patients might
still suffer from unstable angina. Undetectable troponin (far below
the 99th percentile), however, could rule out unstable angina meaning
that such patients could safely be discharged from the emergency
department according to some studies. Therefore, if this were fully
demonstrated, clinical evaluation could play a secondary role.

We investigated clinical data in comparison to undetectable
high-sensitivity troponin in patients with normal high-senstivity
troponin levels (below the 99th percentile).

The main findings indicate that clinical data can guide decision making and perform at
least equally well as undetectable high-sensitivity troponin for
ruling out unstable angina, in patients presenting at the emergency
department with chest pain and normal troponin.

MedicalResearch.com: What should readers take away from your report?

Response: Despite the huge contribution of high-sensitivity troponin for the
diagnosis and prognosis of acute coronary syndromes, clinical
evaluation continues to play an essential role, in particular in those
patients with acute chest pain and normal troponin levels. Scores
built using clinical data are also very valuable tools.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Future research in the field of decision making in acute chest pain
must take into consideration clinical assessment. The development of
new biomarkers should not overshadow clinical evaluation. The present
study does not deny the tremendous contributions of high-sensitivity
troponin but it does not seem realistic that a single laboratory data
can drive decision making in acute chest pain.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:
Clinical evaluation versus undetectable high-sensitivity troponin for assessment of patients with acute chest pain
The American Journal of Cardiology, 09/07/2016
Sanchis J, et al.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on September 9, 2016 by Marie Benz MD FAAD