HIGH SENSITIVITY TROPONIN T: AN AUDIT OF IMPLEMENTATION OF ITS PROTOCOL IN A DISTRICT GENERAL HOSPITAL

Authors

  • Shahid Kalim
  • Shaista Nazir
  • Zia Ullah Khan

Abstract

Background: Protocols based on newer high sensitivity Troponin T (hsTropT) assays can rule in a suspected Acute Myocardial Infarction (AMI) as early as 3 hours. We conducted this study to audit adherence to our Trust’s newly introduced AMI diagnostic protocol based on paired hsTropT testing at 0 and 3 hours. Methods: We retrospectively reviewed data of all patients who had hsTropT test done between 1st and 7th May 2012. Patient’s demographics, utility of single or paired samples, time interval between paired samples, patient’s presenting symptoms and ECG findings were noted and their means, medians, Standard deviations and proportions were calculated. Results: A total of 66 patients had hsTropT test done during this period. Mean age was 63.30±17.46 years and 38 (57.57%) were males. Twenty-four (36.36%) patients had only single, rather than protocol recommended paired hsTropT samples, taken. Among the 42 (63.63%) patients with paired samples, the mean time interval was found to be 4.41±5.7 hours. Contrary to the recommendations, 15 (22.73%) had a very long whereas 2 (3.03%) had a very short time interval between two samples. A subgroup analysis of patients with single samples, found only 2 (3.03%) patient with ST-segment elevation, appropriate for single testing. Conclusion: Our study confirmed that in a large number of patients the protocol for paired sampling or a recommended time interval of 3 hours between 2 samples was not being followed.Keywords: Myocardial Infarction, Troponin T, chest pain, Arrhythmias, Cardiac

References

Young GP, Gibler WB, Hedges JR, Hoekstra JW, Slovis C, Aghababian R, et al. Serial Creatine Kinase-MB results are a sensitive indicator of acute myocardial infarction in chest pain patients with nondiagnostic electrocardiograms: The Second Emergency Medicine Cardiac Research Group Study. Acad Emerg Med 1997;4:869–77.

Alpert JS, Thygesen K, Antman E, Bassand JP. The Joint European Society of Cardiology/American College of Cardiology Committee. Myocardial Infarction redefined –a consensus document of the joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of Myocardial Infarction. J Am Coll Cardiol 2000;36:959–69.

Aldous SJ, Richards MA, Cullen L, Troughton R, Than M. A new improved accelerated diagnostic protocol safely identifies low risk patients with chest pain in emergency department. Acad Emerg Med 2012;19:510–6.

Thygesen K, Mair J, Giannitsis E, Muller C, Lindahl B, Blankenberg S, et al. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur Heart J 2012;33:2252–7.

Mueller M, Biener M, Vafaie M, Doerr S, Keller T, Blankenberg S, et al. Absolute and relative kinetic changes of high senstivity Troponin T in acute coronary syndrome and in patients with acute troponins in the absence of acute coronary syndrome. Clin Chem 2012;58(1):209–18.

Davey RX. Troponin testing: an audit in three metropolitan hospitals. Med J Aust 2003;179:81–3.

Published

2013-07-01

Issue

Vol. 25 No. 3-4 (2013): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

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