Lit Matters #1 - Single vs Serial Troponin in ED Chest Pain

Low-risk ED chest pain can often be ruled out without prolonged observation. In community emergency departments using a conventional troponin assay, a single negative troponin paired with HEART score risk stratification had the same 30-day rate of myocardial infarction or cardiac death as serial testing.

Single vs Serial Troponin

• HEART-guided discharge strategy: A low-risk HEART score was the key companion to a single negative conventional troponin, framing this as selective risk stratification rather than a shortcut.
• Matched 30-day safety signal: Thirty-day myocardial infarction or cardiac mortality after ED discharge was 0.4% in both the single-troponin and serial-troponin groups.
• Conventional assay relevance: These results came from a contemporary conventional troponin-I assay, making the question especially relevant to departments not using high-sensitivity troponin.
• Low yield of repeat testing: Only 66 patients in the serial-testing cohort had a subsequent positive troponin, suggesting the second draw changed management infrequently. We get into the practice implications in the episode.
• Timing caveat: Symptom-onset timing was not available in the dataset, an important limitation because early presenters are the group most likely to benefit from serial sampling.