Can an undetectable high-sensitivity troponin, a non-ischaemic ECG and clinical assessment speed safe discharge for chest pain? This 2020 LoDED trial appraisal examines its inconclusive primary comparison, variation in usual care and the limits of the safety data, keeping clinical judgement central.
JC: Are we fully LoDED? Read More
How do T-MACS, HEART, TIMI and EDACS compare with a troponin-only strategy for suspected cardiac chest pain? This review examines a multicentre study using one high-sensitivity troponin I assay, balancing diagnostic sensitivity and rule-out efficiency against missing data and limits to generalisability.
Risk scores for cardiac chest pain: the first head-to-head comparison! Read More
Could a supplement explain a troponin result that does not fit the clinical picture? Rick Body’s 2018 review explores biotin interference with some troponin assays, the importance of knowing the local test and why supplement histories and discussion with the laboratory can matter.
Troponin and biotin: a lethal combination? Read More
Should patients without ST elevation undergo early coronary angiography after cardiac arrest? This 2017 review examines mortality and neurological outcomes, then challenges the impressive apparent benefit by considering selection bias, retrospective studies and the limited randomised evidence available at the time.
JC: Should non ST elevation ROSC patients go to cath lab? St.Emlyn’s Read More
Does routine oxygen improve outcomes in suspected acute coronary syndromes? This 2017 appraisal of DETO2X-SWEDEHEART examines its patient selection, unexpectedly low event rate and mortality findings, explaining why a non-significant result does not establish that two treatments are equivalent.
JC: Oxygen in ACS. A fuss about nothing? The DETO2X Trial at St.Emlyn’s Read More
Could troponin tell us more than whether a patient has had an infarction? This 2017 reflection explores increasingly sensitive assays, cardiovascular risk and personalised baseline measurements, while distinguishing exciting possibilities from clinical benefits that still needed to be demonstrated.
Troponin: more than a marker of infarction? Read More
Anand Swaminathan revisits his SMACCDub argument for considering thrombolysis in selected patients with submassive pulmonary embolism. This 2017 opinion piece weighs possible functional benefits against major bleeding, emphasising patient selection, shared decisions and the uncertainty in the evidence available then.
Can a single very low high-sensitivity troponin T result, combined with a non-ischaemic ECG, rule out myocardial infarction? Rick Body discusses a 2016 TRAPID-AMI analysis, its promising diagnostic performance and why excluding infarction does not automatically make discharge appropriate.
One high sensitivity troponin test to rule out acute myocardial infarction Read More
