Hachey BJ, Kontos MC, Newby LK, Christenson RH, Peacock WF, Brewer KC, McCord J. Trends in use of biomarker protocols for the evaluation of possible myocardial infarction. J Am Heart Assoc. Sep 22 2017;6(9)
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.
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