RT Journal Article
SR Electronic
T1 Asia-Pacific consensus statement on the optimal use of high-sensitivity troponin assays in acute coronary syndromes diagnosis: focus on hs-TnI
JF Heart Asia
FD BMJ Publishing Group Ltd, British Cardiovascular Society and Asia Pacific Heart Association
SP 81
OP 87
DO 10.1136/heartasia-2016-010818
VO 9
IS 1
A1 Jack Wei Chieh Tan
A1 Carolyn S P Lam
A1 Sazzli Shahlan Kasim
A1 Tar Choon Aw
A1 Joel M Abanilla
A1 Wei-Ting Chang
A1 Van Phuoc Dang
A1 Maria Iboleon-Dy
A1 Sari Sri Mumpuni
A1 Arintaya Phommintikul
A1 Manh Cuong Ta
A1 Punkiat Topipat
A1 Kai Hang Yiu
A1 Louise Cullen
YR 2017
UL http://heartasia.bmj.com/content/9/1/81.abstract
AB Objective High-sensitivity troponin (hs-Tn) assays need to be applied appropriately to improve diagnosis and patient outcomes in acute coronary syndromes (ACS).Methods Experts from Asia Pacific convened in 2015 to provide data-driven consensus-based, region-specific recommendations and develop an algorithm for the appropriate incorporation of this assay into the ACS assessment and treatment pathway.Results Nine recommendations were developed by the expert panel: (1) troponin is the preferred cardiac biomarker for diagnostic assessment of ACS and is indicated for patients with symptoms of possible ACS; (2) hs-Tn assays are recommended; (3) serial testing is required for all patients; (4) testing should be performed at presentation and 3 hours later; (5) gender-specific cut-off values should be used for hs-Tn I assays; (6) hs-Tn I level >10 times the upper limit of normal should be considered to ‘rule in’ a diagnosis of ACS; (7) dynamic change >50% in hs-Tn I level from presentation to 3-hour retest identifies patients at high risk for ACS; (8) where only point-of-care testing is available, patients with elevated readings should be considered at high risk, while patients with low/undetectable readings should be retested after 6 hours or sent for laboratory testing and (9) regular education on the appropriate use of troponin tests is essential.Conclusions We propose an algorithm that will potentially reduce delays in discharge by the accurate ‘rule out’ of non-ACS patients within 3 hours. Appropriate research should be undertaken to ensure the efficacy and safety of the algorithm in clinical practice, with the long-term goal of improvement of care of patients with ACS in Asia Pacific.