The NHRMC Clinical Excellence Troponin Task Force has worked to implement high sensitivity Troponin (hs-T) assays, an updated testing protocol for patients presenting with chest pain and cardiac issues. The new testing standard of care will allow faster evaluation of patients for possible myocardial infarction (heart attack) or ischemia.
Troponins are proteins found in skeletal and heart (cardiac) muscle fibers that regulate muscular contraction. Troponin assays (tests) measure the level of cardiac-specific troponin in the blood to help detect heart injury. Normally, troponin is present in very small to undetectable quantities in the blood. When there is damage to heart muscle cells, troponin is released into the blood. The more damage there is, the greater the concentration in the blood.
Beginning November 3, NHRMC will introduce a new high sensitivity Troponin assay. The new and more sensitive hs-Troponin assay will determine results in an expedient fashion, provide results in whole numbers for easier interpretation, and provide gender specific thresholds.
The project is a result of the joint effort from a number of departments including pathology, cardiology, emergency medicine, and internal medicine with the direction of the clinical excellence team.
“High-sensitivity Troponin is becoming the standard of care for evaluation of patients with chest pain and allows a more rapid diagnosis in most patients. We have developed an algorithm based on published results, using hs-troponin, HEART score and change in troponin values over a 2-hour period that will provide a framework to rule in or rule out cardiac ischemia. The algorithm also helps drive decisions on rapid or standard follow-up in the minority of patients for whom the initial evaluation is inconclusive. We believe this will not only allow a more rapid diagnosis but help reduce clinical variability and result in better care for our patients.” Christopher D. McKinney, M.D., FCAP, Laboratory Medical Director.
Key Changes
- NHRMC will use gender specific thresholds
- Lab results will reflect “High” or “Critical” values specified by gender
- Results will be reported in whole numbers
- The ED will utilize an accelerated troponin strategy of 0 and 2 hour draws
- For inpatient, serial troponin recommendations are 0 and 3 hour draws
- *Timing of draws is extremely important for accurate reporting of results
- The HEART score will be utilized as our risk stratification tool
- Order sets and preference lists will be updated to reflect appropriate serial troponin timed orders