![]() However, it must be noted that the improved detection limit and functional sensitivity has led to some literature suggesting highly sensitive troponins alone may soon be sufficient to rule in or out MI within an hour ( 5 ).Ĭhest pain accounts for 700,000 attendances to Emergency Departments (ED) in England and Wales annually ( 9 ). It has been suggested that POC testing could facilitate more rapid treatment decisions. Mortality risk has been strongly linked to time until treatment ( 8 ), with evidence showing a 1% mortality rate when treatment is implemented within 1 hour of an acute event, compared to 10-12% at 6 hours ( 8 ). Therefore, it has been proposed that myoglobin could be useful for early detection of MI and both myoglobin and CK-MB could be useful for monitoring re-infarction ( 7 ). CK-MB, like troponin, is elevated approximately 6 hours after symptom onset, however, unlike troponin remains elevated for only 24-36 hours (troponin remains elevated for 7-10 days ( 6 ) ). ![]() Myoglobin, however, is detectable within 1-2 hours of symptom onset ( 6 ), and generally returns back to normal levels within 24 hours of symptom onset ( 6 ). One limitation of this current protocol is troponin levels do not increase to a detectable level until 6 hours after the onset of symptoms ( 1 ), although limits of detection of troponin are diminishing with newer assays ( 5 ) (see concluding comments below). ĭue to its high cardiac specificity ( 2 ), the National Institute for Health and Clinical Excellence (NICE) currently recommends testing of troponin I or T on initial presentation to hospital and again 10-12 hours after the onset of symptoms ( 4 ). The detection of these biomarkers - cardiac troponin (cTn), myoglobin and creatine kinase MB isoenzyme (CK-MB) - form the foundation of MI diagnosis ( 2, 3 ). Upon myocardial ischaemia, components of cardiac muscle are released into the blood stream ( 1 ). Myocardial infarction (MI), ‘a heart attack’, is caused by myocardial ischaemia ( 1 ). In patients presenting to Primary Care and the Emergency Department with acute chest pain, what is the prognostic value of a POC panel of cardiac markers compared to standard practice in predicting short-term (up to six-month) future cardiac events?īackground, Current Practice and Advantages over Existing Technology:.In patients presenting to Primary Care and the Emergency Department with acute chest pain, what is the accuracy and utility of a POC panel of cardiac markers compared to standard practice in diagnosing myocardial infarction?.
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