Journal Article

Global Adoption of High-Sensitivity Cardiac Troponins and the Universal Definition of Myocardial Infarction

Shah, Anoop S V, Beshiri, Agim, Jaffe, Allan S, Anand, Atul, Mills, Nicholas L

2019

Overview

The universal definition of myocardial infarction (UDMI) standardizes the approach to the diagnosis and management of myocardial infarction. High-sensitivity cardiac troponin testing is recommended because these assays have improved precision at low concentrations, but concerns over specificity may have limited their implementation. We undertook a global survey of 1902 medical centers in 23 countries evenly distributed across 5 continents to assess adoption of key recommendations from the UDMI. Respondents involved in the diagnosis and management of patients with suspected acute coronary syndrome completed a structured telephone questionnaire detailing the primary biomarker, diagnostic thresholds, and clinical pathways used to identify myocardial infarction. Cardiac troponin was the primary diagnostic biomarker at 96% of surveyed sites. Only 41% of centers had adopted high-sensitivity assays, with wide variation from 7% in North America to 60% in Europe. Sites using high-sensitivity troponin more frequently used serial sampling pathways (91% vs 78%) and the 99th percentile diagnostic threshold (74% vs 66%) than sites using previous-generation assays. Furthermore, high-sensitivity institutions more often used earlier serial sampling (≤3 h) and accelerated diagnostic pathways. Fewer than 1 in 5 high-sensitivity sites had adopted sex-specific thresholds (18%). There has been global progress toward the recommendations of the UDMI, particularly in the use of the 99th percentile diagnostic threshold and serial sampling. However, high-sensitivity assays are still used by a minority of sites, and sex-specific thresholds by even fewer. Additional efforts are required to improve risk stratification and diagnosis of patients with myocardial infarction.

• Publisher: Oxford University Press
• Subject: Acute coronary syndromes / Assaying / Biological Assay - standards / Biomarkers / Biomarkers - analysis / Calcium-binding protein / Cardiology / Diagnosis / Diagnostic systems / Electrocardiography / Global Health - standards / Health care facilities / Health Care Surveys - methods / Heart / Heart attacks / Humans / Laboratories / Low concentrations / Myocardial infarction / Myocardial Infarction - diagnosis / Patients / Polls & surveys / Questionnaires / Reference Standards / Sampling / Sensitivity / Sex / Task forces / Thresholds / Troponin / Troponin I - analysis / Troponin T - analysis