Troponin T can be used to detect missed heart attacks

Around 5-10% of patients who are sent home from the emergency department after presenting with chest pain have missed myocardial infarction. Such patients have usually been identified by detailed case note review, which is not practical as an ongoing audit process. Collinson et al (p 1702) measured concentrations of cardiac troponin T, a cardiac specific marker of myocardial damage with a long diagnostic time window, to audit rates of missed myocardial infarction. They found that 6% of patients discharged with a diagnosis of chest pain of unknown cause had troponin T concentrations indicative of important cardiac damage 12-48 hours after presentation. The test provides a simple method of auditing performance in diagnosing myocardial infarction.

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Relevant Article

Prospective audit of incidence of prognostically important myocardial damage in patients discharged from emergency department • Commentary: Time for improved diagnosis and management of patients presenting with acute chest pain

P O Collinson, S Premachandram, K Hashemi, and R Lee Kennedy
BMJ 2000 320: 1702-1705. [Abstract] [Full Text] [PDF]