Trends in Use of Biomarker Protocols for the Evaluation of Possible Myocardial Infarction

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J Am Heart Assoc


BACKGROUND: Various combinations of creatine kinase-MB, myoglobin, and cardiac troponin I or T (cTnI/cTnT) have been used to evaluate patients with suspected acute coronary syndromes. The current recommendation is to use the 99th percentile of cTnI/cTnT as the sole marker for diagnosis of acute myocardial infarction.

METHODS AND RESULTS: We retrospectively analyzed cardiac marker protocols collected from 824 US hospitals undergoing Chest Pain Center Accreditation through the Society of Cardiovascular Patient Care from 2009 to 2014. Data were obtained by a self-reported survey that addressed cardiac marker(s), sampling time periods, and cut points used for evaluation of suspected acute myocardial infarction. The combination of cTnI or cTnT with creatine kinase-MB was the most commonly used biomarker strategy. Use of cTnI or cTnT as the sole marker increased over time (14-37%;

CONCLUSION: There is considerable variation in cardiac marker testing strategies used in US hospitals for evaluation of suspected acute myocardial infarction. Although increasing, 24% of hospitals used a cTn alone strategy, and only 49% used cTn at the recommended 99th percentile cut point. This has important implications for the diagnosis and treatment of patients with acute myocardial infarction.


© authors, original version available at: 10.1161/JAHA.117.005852

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Medical Subject Headings

Biomarkers; Creatine Kinase, MB Form; Healthcare Disparities; Heart Function Tests; Humans; Myocardial Infarction; Practice Patterns, Physicians'; Predictive Value of Tests; Prognosis; Reproducibility of Results; Retrospective Studies; Troponin I; Troponin T; United States

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