A national survey of troponin testing and recommendations for improved practice

McKeeman, G; Auld, Peter William

doi:10.1177/0004563214568163

Cited by 14 publications

(9 citation statements)

References 47 publications

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“…The UK Association for Clinical Biochemistry and Laboratory Medicine has endorsed the use of a third-party internal quality control material at or near the 99th percentile URL to verify assay reproducibility. Despite this recommendation, only 7% of surveyed laboratories in the UK were running a quality control sample with these characteristics [39].…”

Section: Optimizing Analytical Qualitymentioning

confidence: 99%

“…Even when using the automated approach for HI detection, laboratories differ significantly in their practices for dealing with hemolyzed samples in cTn result reporting. According to a UK survey, 40% of laboratories utilizing hs-cTn T assay removed all results automatically when free hemoglobin is >1 g/L, whilst 10% reported annotated hs-cTn T results indicating possible interference [39]. Other authors have proposed tiered hemolysis thresholds suggesting a protocol for reporting or not hs-cTn T results dependent on marker concentrations [67].…”

Section: Understanding the Impact Of Pre-analytical And Analytical Inmentioning

confidence: 99%

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Laboratory-related issues in the measurement of cardiac troponins with highly sensitive assays

Krintus

Panteghini

2020

Clinical Chemistry and Laboratory Medicine (CCLM)

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A number of assay-related issues can affect the performance of cardiac troponin (cTn) measurement in everyday practice. In this respect, it is vital that all information on cTn assays is known and that the performance characteristics of assays are objectively assessed and adequately described. The advent of the latest generation of more sensitive cTn assays has heralded a new wave of information about low concentrations of cTn in blood. These recent generation assays have improved analytical sensitivity and corresponding performance at low cTn concentrations when compared to their predecessors, providing a convincing goal for laboratory medicine in helping clinicians in the diagnosis of acute myocardial infarction. Crucial to the clinical utility of highly sensitive cTn assays is the laboratorians’ role in closely scrutinizing proposed assays and defining their value in relation to available evidence. Analytical, as well as pre-analytical and post-analytical, aspects must be documented. In this review, we describe what laboratory professionals should know about their cTn assay performance characteristics and the pre-analytical prerequisites for robustness to ensure optimal post-analytical reporting.

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Section: Optimizing Analytical Qualitymentioning

confidence: 99%

Section: Understanding the Impact Of Pre-analytical And Analytical Inmentioning

confidence: 99%

Laboratory-related issues in the measurement of cardiac troponins with highly sensitive assays

Krintus

Panteghini

2020

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…We have therefore implemented duplicate analysis of any retrospective troponin requests to avoid false positive results, as this incident showed. Focusing initially on the analytical and pre-analytical stages of troponin testing, our approach to implementing the Abbott Architect hs-cTnI assay, a level 4 high sensitivity assay [2] , agrees with all of the recommendations of a recent national audit of troponin testing [26] . We also strongly endorse the recommendation for assessing imprecision and maintaining control (using 3rd party QC material), particularly at the 99th percentile, as we are cognisant of the potential clinical implications when assay performance is undesirable at such thresholds, as highlighted previously by Apple and Jaffe [27] .…”

Section: Discussionmentioning

confidence: 67%

“…Our decision to use gender-specific cut-offs therefore remained, with the added benefit of helping to rebalance the reported gender inequality in diagnosis and management of ACS [30] . Whilst the recent national audit on troponin testing [26] does not give specific recommendation for the use of gender-specific thresholds per se , it does recognise a need for assay manufacturers to provide gender-related data so that users can consider any such differences. The audit also commented upon the possible importance of age-related reference values, given the reported relationship of increasing age with higher troponin concentrations [31] .…”

Section: Discussionmentioning

confidence: 99%

Transitioning high sensitivity cardiac troponin I (hs-cTnI) into routine diagnostic use: More than just a sensitivity issue

Lee

Browne

Guest

et al. 2016

Practical Laboratory Medicine

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ObjectivesHigh sensitivity cardiac troponin T and I (hs-cTnT and hs-cTnI) assays show analytical, diagnostic and prognostic improvement over contemporary sensitive cTn assays. However, given the importance of troponin in the diagnosis of myocardial infarction, implementing this test requires rigorous analytical and clinical verification across the total testing pathway. This was the aim of this study.Design and methodsAnalytical verification included assessment of critical outlier frequency, for hs-cTnI and cTnI assays. Concordance for paired cTnI and hs-cTnI measurements (n=1096) was verified using 99th percentiles for both genders (cTnI: 30 ng/L, hs-cTnI: 25 ng/L) and for men and women separately (hs-cTnI: M: 34;F: 16 ng/L). Discordant data was correlated with clinical and laboratory information. Diagnosis of Acute Coronary Syndrome (ACS) or Non-ACS was adjudicated by two cardiologists independently.ResultsThe hs-cTnI assay showed a lower (10-fold) critical outlier rate (0.091%) and more detectable results above the limit of detection (LOD) (23.4%) and 99th percentile (2.4%), compared to cTnI. Analytical concordance between the two assays was high (94.5%) but decreased (91.7%) when gender-specific hs-cTnI cut-offs were used. The hs-cTnI assay gave fewer false negatives (up to 1.0%) but disproportionately more false positives (up to 6.7%) overall, which improved (3.9%) for serial measurements.ConclusionsLaboratories should analytically and clinically verify hs-cTn assays before use, with attention to performance and the clinical and diagnostic algorithms that support appropriate testing and result interpretation. Work in the pre- and post-analytical phases is necessary to augment the analytical improvement in the new era of troponin testing.

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“…The most commonly used assay is the Roche high-sensitivity troponin T. Timing of sampling varies, with most Trusts recommending sampling at 0 and 3 hours, but some recommending shorter time intervals. The findings suggest that availability of high-sensitivity troponin has increased since a survey of 94 hospital laboratories in 2015 reported that 60% had implemented a high-sensitivity troponin assay 4. A recent international survey reported that 72% of 80 UK sites use high-sensitivity troponin, with serial sampling at 3–6 hours in 78% 5.…”

Section: Discussionmentioning

confidence: 97%

Implementation of rapid rule out of myocardial infarction using high-sensitivity troponin: cross-sectional survey of English hospitals

2020

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ObjectivesRecent guidance recommended use of high-sensitivity troponin for rapid rule out of myocardial infarction (MI) in the English health service. We aimed to determine the extent of implementation of this guidance across English hospitals.MethodsThis study conducted a cross-sectional questionnaire survey of 131 English acute hospitals with over 10 000 admissions per year.ResultsWe received 125/131 responses (95%), with 110/125 (88%) reporting use of a high-sensitivity troponin assay and responses showing progressive implementation over the last 10 years. High-sensitivity troponin was reported to be used for rapid rule out of MI in 92/110 Trusts (84%). Review of guidelines received from 95/110 Trusts identified that 71/95 (75%) provided guidance for rapid MI rule out with high-sensitivity troponin: 57 recommended testing at 0 and 3 hours, 4 recommended testing at 0 and 2 hours, and 9 recommended testing at 0 and 1 hour, and timing was unclear at one Trust.ConclusionsEnglish acute hospital Trusts report widespread implementation of high-sensitivity troponin for rapid rule out of MI, with most recommending testing at 0 and 3 hours.

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A national survey of troponin testing and recommendations for improved practice

Cited by 14 publications

References 47 publications

Laboratory-related issues in the measurement of cardiac troponins with highly sensitive assays

Laboratory-related issues in the measurement of cardiac troponins with highly sensitive assays

Transitioning high sensitivity cardiac troponin I (hs-cTnI) into routine diagnostic use: More than just a sensitivity issue

Implementation of rapid rule out of myocardial infarction using high-sensitivity troponin: cross-sectional survey of English hospitals

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