Need some cards input...

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Groove

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Hey guys, it's your friendly EP here.. Would some cardiologists mind weighing in on a discussion we had going about utility of Trop vs Trop + CKMB? I think most of us are aware of the CRUSADE and GRACE registries and I've always been under the impression that CKMB was essentially worthless but I do seem to find a few dissenting voices in the cardiac literature. Most of the cards guys where I work seem to only prefer Troponin I and consider any other enzyme worthless. I currently never order anything other than Troponins but you'll find plenty of places where they are ordered in conjunction with CKMB's.

Anybody care to weigh in with some evidence based stuff? Thanks.

http://forums.studentdoctor.net/showthread.php?t=936297

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I hate the "single troponins" ordered in the ER, which are often positive for reasons other than acute coronary syndrome. It's especially bad now that there is the so-called "Ultrasensitive Troponin". I think the CK-MB sometimes helps differentiate the true acute coronary syndromes from the "I have a positive troponin but I'm not having a heart attack" patients. Usually this can be done by clinical exam, exam of ECG and a history, but it's very hard to convince hospitalists or ER docs of this. Once the troponin is positive, even if it's only 0.07 or something, they often will insist on a cardiology admission, which isn't always good for the patient if the underlying problem that brought them to the ER was not cardiac-related.
 
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