In Reply

The Interdisciplinary Management of Acute Chest Pain by Dr. med. Raphael R. Bruno, Prof. Dr. med. Norbert Donner-Banzhoff, Prof. Dr. med. Wolfgang Söllner, Prof. Dr. med. Thomas Frieling, Prof. Dr. med. Christian Müller, and Prof. Dr. med. Michael Christ in issue 45/2015

We thank the authors for the numerous discussions initiated by our article „The Interdisciplinary Management of Acute Chest Pain“ (1). Our colleague Dr. Bambach refers to other important causes of acute chest pain, such as herpes zoster in its initial stage and additional distinct manifestations of skeletal and muscular problems, the clinical significance of which is widely accepted. Unfortunately, we could not address all of these important aspects due to limitations in the scope of our article. Many of the causes referred to by Dr. Bambach are in turn closely related to non-somatic causes of pain in general, and to chest pain in particular. For this reason, orthopedic surgeons and pain specialists should also be included in the treatment plan as a matter of course.

Dr. Zur refers to the potential hazards associated with the clinical introduction of a 0-/1-h algorithm for evaluating acute chest pain (2). He points out that, in the current ESC guidelines (3), the hs-cTnI assay (Dimension Vista, Siemens Healthcare) mentioned for this algorithm is not currently commercially available in Germany and could possibly be confused with a distinct one that is on the market. We would like to explicitly affirm the importance of involving a competent specialist—in this case, a laboratory physician—when new algorithms are introduced to clinical routine and emergency diagnostics, to ensure a high level of patient safety. Meanwhile, a large multicenter prospective study of the algorithm proposed in the ESC guidelines has been prospectively validated for the hs-TnT assay (Roche Diagnostics) (4).

DOI: 10.3238/arztebl.2016.0362c

Dr. med. Raphael Romano Bruno

Prof. Dr. med. Michael Christ

Universitätsklinik der Paracelsus Medizinische Privatuniversität

Klinikum Nürnberg

Conflict of interest statement

Prof. Christ has received consulting honoraria, reimbursement for scientific conference preparation, and research support (third-party funding) for both self-initiated projects, as well as for clinical trials conducted on their behalf, from Roche Diagnostics Alere GmbH and Philips GmbH.

 Dr. Bruno declares that no conflict of interest exists.

References

1. Bruno RR, Donner-Banzhoff N, Söllner W, Frieling T, Müller C, Christ M: The interdisciplinary management of acute chest pain. Dtsch Arztebl Int 2015; 112: 768–80

2. Zur B, Stoffel-Wagner B: Misleading high-sensitivity troponin algorithm for NSTEMI in the ESC guidelines. Clin Chem Lab Med 2015; 53: e323

3. Roffi M, Patrono C, Collet JP, et al.: 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2016; 37: 267–315

4. Mueller C, Giannitsis E, Christ M, et al.: Multicenter evaluation of a 0-hour/1-hour algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T. Ann Emerg Med 2016; pii: S0196–0644.