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War on Troponinitis: How to Beat the Plague, at #RCEM16beach

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Rick Body
Rick Body

They say that modern medicine is facing a plague of troponinitis thanks to high sensitivity troponin. Is it true? How do we beat it? In this presentation I covered everything from troponin reference ranges to sex-specific cut-offs to absolute delta changes. My talk from #RCEM16beach, the Annual Scientific Conference of the Royal College of Emergency Medicine

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War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
Troponin as marker of myocardial injury
The Multiple Causes of Troponin Elevation
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
T H E RE 'S A GOOD REASON W H Y T H E C U T - OFF IS SO LOW! But... 7 39 24 5 21 24 0 10 20 30 40 50 <0.05 0.05-0.19 >0.2 % with death or AMI after a year Validation Implementation M i l l s e t a l , J A M A 2 0 11 ; 3 0 5 ( 1 2 ) : 1 2 1 0 - 6
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach
War on Troponinitis: How to Beat the Plague, at #RCEM16beach

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War on Troponinitis: How to Beat the Plague, at #RCEM16beach

  • 8. Troponin as marker of myocardial injury
  • 9. The Multiple Causes of Troponin Elevation
  • 16. T H E RE 'S A GOOD REASON W H Y T H E C U T - OFF IS SO LOW! But... 7 39 24 5 21 24 0 10 20 30 40 50 <0.05 0.05-0.19 >0.2 % with death or AMI after a year Validation Implementation M i l l s e t a l , J A M A 2 0 11 ; 3 0 5 ( 1 2 ) : 1 2 1 0 - 6

Editor's Notes

  • #3: What is troponinitis?
  • #4: So when high sensitivity troponin came along we were so happy. These were the scenes at one of the many high sensitiivity troponin parties we had at my house and I’m sure you had similar troponin parties too. It was crazy. Here was a test that promised to allow us to rule out acute coronary syndromes much quicker. High sensitivity troponin – our saviour! This promised earlier detection of myocardial injury, it promised to “kill off” unstable angina, it was – quite simply – an awesome prospect. These were the scenes in Manchester when we heard that high sensitivity troponin was on the horizon. What a party – oh, what a year. And I guess, while we were busy partying, the scenes must have been pretty similar across the world right, Louise?
  • #5: This is a picture of one of our cardiologists when he found out that we were implementing high sensitivity troponin in Manchester. Lots of people are worried about the false positives, particularly cardiologists. They’re worried that these tests might lead to more unnecessary referrals, more unnecessary stress tests, CT scans, angiograms and so on. And there’s also another group of people, who are neither happy about this situation nor angry. What is HS troponin Firstly – no such thing HS ASSAYS
  • #8: The hs-cTn assays: Roche and Abbott
  • #11: Rick
  • #19: Age
  • #22: Gender