J Sanchis, V Bodí, Á Llácer, J Núñez, L Consuegra, M J Bosch, V Bertomeu, V Ruiz, and F J Chorro

Risk stratification of patients with acute chest pain and normal troponin concentrations
Heart 2005; 91: 1013-1018 [Abstract] [Full text] [PDF]

j.zaman{at}ucl.ac.uk Justin S Zaman

We should all remember our clinical skills and the evidence that existed in B.T. (Before Troponin) times. I still take a convincing cardiac history and suspicious ECG changes seriously and ignore the first troponin, keeping the patient in at least 24 hours and measuring a second troponin/creatinine kinase, or exercising the patient if further pain occurs. We should all be wary of becoming too dependant on perceived panacea's like Troponin or d-dimer, and lead clinicians and academics must constantly remind us to still examine the broad picture which is comprised of many clues and not just one piece (albeit an important one) of the puzzle.