Apologies for raising this old chestnut, it was raised last year but with no obvious conclusion.
Our Pathology Network has been asked by the Cardiac Network for views on the cut-off for troponin in the diagnosis of myocardial infarction.
Is everyone/anyone adopting the British Cardiac Society Working Group recommendation that:
ACS with unstable angina = clinical syndrome with undetectable troponin
ACS with myocyte necrosis = "a typical clinical syndrome" with an detectable (?) cTnT less than 1 ng/mL or detectable AccuTnI less than 0.5 microgrammes per Litre
ACS with Clinical MI = "a typical clinical syndrome" with a "maximum troponin T increase (?)" greater than 1 ng/mL or AccuTnI greater than 0.5 microgrammes per Litre
Or are people adopting the following approach, or similar (provided by another Pathology Network, thanks PH)
(1) Trop T < 0.01ug/L: No cardiac damage detected, assuming sample taken at least 12 hours post-onset of chest pain. Does NOT exclude angina as the cause of chest pain.
(2) Trop T 0.01-0.05 ug/L: Possible cardiac damage. Suggest repeat in 4 to 6 hours if sample not taken >12hrs post chest pain.
(3) Trop T >0.05ug/L: Definite cardiac damage.
The critical difference is that with the BCSWG there is a troponin-related definition of MI, but with the other, Troponin gives a view on whether cardiac damage is present but goes no further.
regards
martin myers
This message and any files transmitted with it are confidential and intended
solely for the individual(s) addressed. If you have received this e-mail in
error, disclosing, copying, distributing or retaining this message or any part
of it is strictly prohibited; please notify the sender immediately and delete it
from your system. Any views or opinions presented are solely those of the author
and do not necessarily represent those of Lancashire Teaching Hospitals NHS
Trust. The Trust accepts no liability for any damage caused by any virus
transmitted with this e-mail, so although virus checked before transmission, the
recipient should also check for the presence of viruses.
The information contained in this email may be subject to public disclosure under
the NHS Code of Openness or the Freedom of Information Act 2000. Unless the
information is legally exempt from disclosure, the confidentiality of this email and any
subsequent reply cannot be guaranteed.
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical
community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
|