The Asia-Pacific Society of Cardiology (APSC) Expert Committee Consensus Recommendations for Assessment of Suspected Acute Coronary Syndrome Using High-Sensitivity Cardiac Troponin T in the Emergency Department

Abstract

The Asia-Pacific Society of Cardiology (APSC) high-sensitivity troponin T (hs-TnT) consensus recommendations and rapid algorithm were developed to provide guidance for healthcare professionals in the Asia-Pacific region on assessing patients with suspected acute coronary syndrome (ACS) using a hs-TnT assay. Experts from Asia-Pacific convened in 2 meetings to develop evidence-based consensus recommendations and an algorithm for appropriate use of the hs-TnT assay. The Expert Committee defined a cardiac troponin assay as a high-sensitivity assay if the total imprecision is ≤10% at the 99th percentile of the upper reference limit and measurable concentrations below the 99th percentile are attainable with an assay at a concentration value above the assay's limit of detection for at least 50% of healthy individuals. Recommendations for single-measurement rule-out/rule-in cutoff values, as well as for serial measurements, were also developed. The Expert Committee also adopted similar hs-TnT cutoff values for men and women, recommended serial hs-TnT measurements for special populations, and provided guidance on the use of point-of-care troponin T devices in individuals suspected of ACS. These recommendations should be used in conjunction with all available clinical evidence when making the diagnosis of ACS.

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“…1 ). Consenting patients who were diagnosed and treated with a primary cardiovascular event at the First Affiliated Hospital of the USTC, in accordance with the criteria of ACS diagnosis and treatment guidelines [ 16 , 17 ] were enrolled in the study. Informed consent was obtained and signed.…”

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“…They are instead encouraged to consider alternative diagnoses, and to recommend patients at discharge to seek follow-up if their symptoms have not improved within 7 days and to return to the ED in case symptoms progress. We chose an increase instead of delta in this setting, as this was felt to be clinically sensible and in line with guideline recommendations [8, 18].…”

“…They are instead encouraged to consider alternative diagnoses, and to recommend patients at discharge to seek follow-up if their symptoms have not improved within 7 days and to return to the ED in case symptoms progress. We chose an increase instead of delta in this setting, as this was felt to be clinically sensible and in line with guideline recommendations [8,18]. A final diagnosis of STEMI during the index visit, as this diagnosis is not based on blood biomarkers No hs-cTnT ordered, as this signifies no suspicion of acute coronary syndrome Leaving the ED against medical advice No Swedish personal identity number, because those patients cannot be followed up via national registries Previous enrollment: patients will only be enrolled during their first ED visit Patients who actively decline participation; this study has received ethical approval without the need for written informed consent; information will however be posted in the EDs informing patients that data will be collected from the electronic health records and registries, and that they can withdraw from participation at any time, without specific reason by contacting the study administration ED, emergency department; hs-cTnT, high-sensitivity cardiac troponin T; STEMI, ST-elevation myocardial infarction.…”

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“…On admission, he had a heart rate of 130bpm, BP of 100/70mmhg, and SpO2 measuring 93% on room air. An electrocardiogram (ECG) coupled with a high sensitivity troponin T(hs-TnT) value of 217ng/L (normal value-<15ng/L ) done at the hospital, was suggestive of a non-ST segment elevated myocardial infarction (NSTEMI), complicated with clinical features suggestive of congestive cardiac failure (CCF) [ 5 ]. The patient denied any complaints of night sweats, weight loss, nausea, vomiting, or any change in bowel bladder habits.…”