On this Journal Jam 5, One Hour Troponin to Rule in and out MI we're gonna mix things up a bit and have a special guest discuss a very hot topic: clinical decision tools using high sensitivity troponin to rule out MI in patients who present to the ED with chest pain in a short time window of an hour or two or three.

Traditionally we've run at least 2 troponins 6 or 8 hours apart to help rule out MI and recently in algorithms like the HEART score we've combined clinical data with a 2 or 3 hour delta troponin to help rule out MI.  The paper we'll be discussing here is a recent multicentre/multinational study from the Canadian Medical Association Journal out of Switzerland entitled "Prospective validation of a 1 hour algorithm to rule out and rule in acute myocardial infarction using a high sensitivity cardiac troponin T assay" with lead author Tobias Reichlin. It not only looks at whether or not we can rule out MI using a delta troponin at only 1 hour, but whether or not we can expedite the ruling in of MI using this protocol.

Teresa Chan took a well deserved break from co-hosting this Journal Jam, and instead we have a special guest, the King of Critical Appraisal himself, the brains behind BEEM - Best Evidence in EM, Dr. Andrew Worster from McMaster University. This is the start of a new collaborative effort for our upcoming series BEEM Cases, a blog with Justin Morgenstern (First10EM) and Rory Spiegel (EM Nerd) where important clinical questions answered by a series of articles are run through the BEEM critical appraisal team engine and then presented in an engaging educational blog on EM Cases. We'd love to hear your comments on One Hour Troponin to Rule In and Out MI below.