Does anyone have any experience in applying Troponin-I levels for the
administration of anti-Gp IIb/IIIa (or anti-platelet) agent in acute
coronary syndrome? We are implementing Dade Stratus CS for TnI measurement.
Ideally I think we should establish our own TnI reference range for the
diagnosis of acute coronary syndrome because the TnI assays are not
universally standardized. However, I understand that manufacturers do
provide limited data from clinical trials on their specific assay for the
establishment of their reference interval for diagnosis of acute coronary
syndrome. We users can adopt this set of figures provided we verify this
with a small-scale study of our own.
My question is: to what extent do other users go in this verification
process? I understand that to absolutely exclude acute myocardial
infarction, which means we need to go beyond ECG and laboratory diagnoses -
ie require echocardiogram, radionucleotide scans and coronary angiograms,
tests which have higher specificity in diagnoisis of AMI. In my opinion this
is out of our ability in a small community hospital.
Thank you for your input.
|