Day 3 began with the excellent Session 696: Battles in the Emergency Room over Management of Possible ACS. Pollack, Mueller, Hollander, Than et al covered most of the big questions in this area with all the strengths and weaknesses of clinical assessment, risk stratification, biomarkers and non-invasive testing, especially CT coronary angiography (CTCA) of course. Whilst there are many answers it’s also clear that many questions remain.
Christian Mueller, as you’d expect, provided a great overview of the benefits of the increasingly sensitive troponin assays in this context. What many people don’t realise is that none of the high sensitivity troponin assays available elsewhere have yet been approved for clinical use in the US. But it is very likely that they will be over the next 18 months and so there is quite intense interest in this now. Martin Than had sent the scene for all of this with much of our own data including the ASPECT and ADAPT studies along with what I think was the first look at the results of Louise Cullen’s highly sensitive troponin I data (which is now in press in the Journal of the American College of Cardiology).
The debate over CTCA has, I think, some time to run. Judd Hollander makes a compelling case for this as the ‘best test’ for ruling out coronary disease in patients with chest pain but then he works in a hospital where the test is available until 10pm each night and for four hours on Saturdays and Sundays!!!
And from there it was on to have our poster moderated…