Introduction & Agenda

  1. Letter to Participants from Roundtable Co-Chairs, Drs. Michael Kontos and James de Lemos
  2. Emergency Department Evaluation of Patients with Possible ACS Agenda
  3. Emergency Department Evaluation of Patients with Possible ACS Interactive Table Discussion Questions

Session 1: Defining the Landscape for Troponin Testing

  1. Shah ASV, Anand A, Strachan FE et al. High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial. Lancet (London, England) 2018;392:919-928.
  2. Anand A, Shah ASV, Beshiri A, Jaffe AS, Mills NL. Global Adoption of High-Sensitivity Cardiac Troponins and the Universal Definition of Myocardial Infarction. Clinical chemistry 2019;65:484-489. (6pgs)
  3. Gore MO, Seliger SL, Defilippi CR et al. Age- and sex-dependent upper reference limits for the high-sensitivity cardiac troponin T assay. Journal of the American College of Cardiology 2014;63:1441-8.
  4. Hickman PE, Lindahl B, Potter JM, Venge P, Koerbin G, Eggers KM. Is it time to do away with the 99th percentile for cardiac troponin in the diagnosis of acute coronary syndrome and the assessment of cardiac risk? Clinical chemistry 2014;60:734-6.
  5. Januzzi JL, Jr., Mahler SA, Christenson RH et al. Recommendations for Institutions Transitioning to High-Sensitivity Troponin Testing: JACC Scientific Expert Panel. Journal of the American College of Cardiology 2019;73:1059-1077.

Session 2: Biomarker Based Strategies for Exclusion of Acute MI

  1. Than MP, Pickering JW, Dryden JM et al. ICare-ACS (Improving Care Processes for Patients With Suspected Acute Coronary Syndrome): A Study of Cross-System Implementation of a National Clinical Pathway. Circulation 2018;137:354-363.
  2. Roffi M, Patrono C, Collet J et al. 2015 ESC Guidelines for the Management of Acute Coronary Syndromes in Patients presenting without Persistent ST-Segment Elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). European Heart Journal 2016, 37:267–315. (Pages 275-278).
  3. Vigen R, Kutscher P, Fernandez F et al. Evaluation of a Novel Rule-Out Myocardial Infarction Protocol Incorporating High-Sensitivity Troponin T in a US Hospital. Circulation 2018;138:2061-2063.
  4. Cullen LA, Mills NL, Mahler S, Body R. Early Rule-Out and Rule-In Strategies for Myocardial Infarction. Clinical chemistry 2017;63:129-139.

Session 3: Role of Noninvasive Testing

  1. Chapman AR, Hesse K, Andrews J et al. High-Sensitivity Cardiac Troponin I and Clinical Risk Scores in Patients With Suspected Acute Coronary Syndrome. Circulation 2018;138:1654-1665.
  2. Twerenbold R, Costabel JP, Nestelberger T et al. Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction. Journal of the American College of Cardiology 2019;74:483-494.
  3. Hollander JE, Than M, Mueller C. State-of-the-Art Evaluation of Emergency Department Patients Presenting With Potential Acute Coronary Syndromes. Circulation 2016;134:547-64.
  4. Rybicki FJ, Udelson JE, Peacock WF et al. 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain. A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force 2016;67:853-879. (Pages 853-867, 873-876).
  5. Hulten E, Pickett C, Bittencourt MS, et al. Outcomes after coronary computed tomography angiography in the emergency department: a systematic review and meta-analysis of randomized, controlled trials. Journal of the American College of Cardiology. 2013;61:880-92.
  6. Raff GL, Hoffmann U, Udelson JE. Trials of Imaging Use in the Emergency Department for Acute Chest Pain. JACC Cardiovascular imaging. 2017;10:338-49.
  7. Miller CD, Case LD, Little WC, et al. Stress CMR reduces revascularization, hospital readmission, and recurrent cardiac testing in intermediate-risk patients with acute chest pain. JACC Cardiovascular imaging. 2013;6:785-94.
  8. Greenwood JP, Ripley DP, Berry C, et al. Effect of Care Guided by Cardiovascular Magnetic Resonance, Myocardial Perfusion Scintigraphy, or NICE Guidelines on Subsequent Unnecessary Angiography Rates: The CE-MARC 2 Randomized Clinical Trial. JAMA. 2016;316:1051-60.
  9. Hess EP, Hollander JE, Schaffer JT et al. Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial. BMJ (Clinical research ed) 2016;355:i6165.

Additional References
Not included in this book

  1. Boeddinghaus J, Nestelberger T, Twerenbold R et al. Direct Comparison of 4 Very Early Rule-Out Strategies for Acute Myocardial Infarction Using High-Sensitivity Cardiac Troponin I. Circulation 2017;135:1597-1611.
    https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.116.025661?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed.
  2. Greenslade JH, Carlton EW, Van Hise C et al. Diagnostic Accuracy of a New High-Sensitivity Troponin I Assay and Five Accelerated Diagnostic Pathways for Ruling Out Acute Myocardial Infarction and Acute Coronary Syndrome. Annals of emergency medicine 2018;71:439-451.e3.
    https://www.annemergmed.com/article/S0196-0644(17)31867-X/fulltext.
  3. Lee KK, Noaman A, Vaswani A et al. Prevalence, Determinants, and Clinical Associations of High- Sensitivity Cardiac Troponin in Patients Attending Emergency Departments. The American journal of medicine 2019;132:110.e8-110.e21.
    https://www.amjmed.com/article/S0002-9343(18)30955-0/fulltext,
  4. Nestelberger T, Wildi K, Boeddinghaus J et al. Characterization of the observe zone of the ESC 2015 high-sensitivity cardiac troponin 0h/1h-algorithm for the early diagnosis of acute myocardial infarction. International journal of cardiology 2016;207:238-45.
    https://www.internationaljournalofcardiology.com/article/S0167-5273(16)30099-7/fulltext.
  5. Twerenbold R, Badertscher P, Boeddinghaus J et al. Effect of the FDA Regulatory Approach on the 0/1-h Algorithm for Rapid Diagnosis of MI. Journal of the American College of Cardiology 2017;70:1532-1534.
    http://www.onlinejacc.org/content/70/12/1532

Presentations