Improved efficiency and cost reduction in the emergency department by replacing contemporary sensitive with high-sensitivity cardiac troponin immunoassay
Commentary to the Article on high-sensitivity cardiac troponin immunoassay. Acta Biomed 2019; 90(4):414-620
Keywords:
troponin immunoassay; non-ST elevation coronary syndromes (NSTEMI)Abstract
The Authors planned this study to evaluate the impact of replacing a contemporary-sensitive with HS cTnI immunoassay on hospital and laboratory workload.
The authors say that, ‘Despite some evidence, the clinicians are still hesitant to replace the former so-called contemporary-sensitive methods with HS-cTn techniques, justifying this reluctance with concerns of overutilization, possible over diagnosis of cardiac injuries, overcrowding of emer-gency departments (EDs), and excess of cardiac invasive testing. Several factors have lead clinicians to use terms such as “troponin leak”, “false-positive” troponin elevation, or “troponinemia”. The results of this study show substantial organizational and economic benefits by replacing con-temporary-sensitive with HS cTnI immunoassays. This is very important question because there are some areas such as acute non-ST elevation coro-nary syndromes (NSTEMI) and in elderly patients, the specificity is very low for the simultaneous presence of factors that can alter the dosage of HS-cTnI values.
References
Newby LK, Jesse RL, Babb JD, Christenson RH, De Fer TM, Diamond GA, et al. ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2012;60:2427–63.
Vafaie M, Biener M, Mueller M, Schnabel PA, André F, Steen H, et al. Analytically false or true positive elevations of high sensitivity cardiac troponin: A systematic approach. Heart. 2014;100:508–14
‘HIGH-SENSITIVITY TROPONIN ASSAYS EXHIBIT PROHIBITIVELY HIGH FALSE POSITIVE RATES FOR MYOCARDIAL INFARCTION IN THE ELDERLY: FINDINGS FROM THE AGES REYKJAVIK STUDY Tushar Acharya and coll, on Jour-nal of the American College of Cardiology Volume 71, Issue 11 Supplement, March 2018,
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