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if ekg is abnormal the disposition is easier to make.
the issue is what to do if ekg is normal? how to use the troponin?
--article from 9/13 bmj suggests algorithm
--new data from sweden suggests single value sufficient if low trop and normal ekg
i would argue that to use either of these or a combo of the two then we need to reconsider pretest probability of coronary artery disease in out pts and consider some other scales that can help us. one example is to use the TIMI scoring system and/or statistical odds that a particular pt. has CAD
new data from sweden suggests if ekg is normal and single first trop is undectable, ie <5 then no acs and discharge is ok
i think we can use a combo of NICE/European data and BMJ algorithm (BMJ sept. 28, 2013) and the swedish data (JACC march 2014)
if #1 trop is > 3 hours from pain onset and < 5 and the EKG is normal then i think you can stop acs w/u
otherwise, follow the bmj algorithm
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