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

Overview

Journal J Am Heart Assoc

Specialty Cardiology & Vascular Diseases

Date 2017 Sep 24

PMID 28939707

Citations 8

Authors

Brian J Hachey

Michael C Kontos

L Kristin Newby

Robert H Christenson

W Frank Peacock

Katherine C Brewer

James McCord

Affiliations

Soon will be listed here.

Abstract

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%; <0.0001), as did use of the 99th percentile cut point for cTnI/cTnT (30-60%; <0.0001).

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.

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