Troponin and other cardiac markers: role in management of acute coronary syndromes.
Many adjuncts to the traditional history, physical examination, and baseline ECG have been developed to improve the differential diagnosis of acute coronary syndromes in the Emergency Department (ED). These include serial ECGs, continuous ST-segment monitoring, and serum markers of myocardial necrosis. In general, the serum markers of coronary ischaemia, particularly the troponins, provide the most information toward initial and later risk stratification. Serial marker measures not only increase the sensitivity and negative predictive value for acute infarction (thus reducing hospital costs) but also can add to prognostic ability. More importantly, a positive marker result indicates an increased risk of an early event, which could allow earlier intervention and thus a better outcome.
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