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[Unstable angina: a diagnosis of the past]

Jaap W Deckers1, Felix Zijlstra

  • 1Erasmus MC, Thoraxcentrum, afd. Cardiologie, Rotterdam.

Nederlands Tijdschrift Voor Geneeskunde
|February 4, 2016
PubMed

Insights

Acute coronary syndrome diagnoses are evolving with sensitive cardiac troponin tests. Patients with undetectable troponin levels have very low risk, necessitating clinical assessment for non-cardiac symptoms.

Area of Science:

  • Cardiology
  • Clinical Diagnostics

Background:

  • Acute coronary syndrome (ACS) encompasses myocardial infarction (MI) and unstable angina (UA).
  • The definition and diagnostic criteria for UA are continually evolving.
  • Advancements in high-sensitive cardiac troponin (hs-cTn) assays impact ACS diagnosis.

Purpose of the Study:

  • To evaluate the diagnostic implications of hs-cTn assays in ACS.
  • To clarify the classification of patients with chest pain and very low hs-cTn levels.
  • To determine the appropriate clinical approach for patients with negative hs-cTn results.

Main Methods:

  • Review of clinical data and hs-cTn assay results.
  • Analysis of risk stratification for patients presenting with chest pain.
  • Assessment of diagnostic criteria for unstable angina.

Main Results:

  • Widespread use of hs-cTn assays leads to more MI diagnoses over UA.
  • Patients with undetectable hs-cTn levels (< 0.05 ng/L) demonstrate an extremely low risk of MI and death.
  • These low-risk patients cannot be classified as having UA.

Conclusions:

  • The diagnostic landscape for ACS is shifting due to hs-cTn sensitivity.
  • A threshold of undetectable hs-cTn effectively identifies patients at minimal cardiac risk.
  • Clinical judgment is crucial for diagnosing the cause of symptoms in these patients, as they are often non-cardiac.

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