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Appropriate use of serum troponin testing in general practice: a narrative review

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In this article, we review the evidence regarding troponin testing in a community setting, particularly relating to new information on the utility of high sensitivity assays and within the context of contemporary guidelines for the management of chest pain and the acute coronary syndrome. For this review, we synthesised relevant evidence from PubMed-listed articles published between 1996 and 2016 and our own experience to formulate an evidence-based overview of the appropriate use of cardiac troponin assays in clinical practice. We included original research studies, focusing on high quality randomised controlled trials and prospective studies where possible, systematic and other review articles, meta-analyses, expert consensus documents and specialist society guidelines, such as those from the National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand. This article reflects our understanding of current state-of-the-art knowledge in this area.

What is the purpose of the serum troponin assay?

The troponin assay was designed to assist in diagnosis and improve risk stratification for people presenting in the emergency setting with symptoms suggestive of an acute coronary syndrome.1,2 These symptoms include:

  • chest, jaw, arm, upper back or epigastric pain or pressure

  • nausea