Biochemical diagnosis of myocardial infarction evolves towards ESC/ACC consensus: experiences from the Nordic countries.
OBJECTIVE
To investigate the diagnostic approach in Nordic hospitals receiving patients suspected of acute myocardial infarction (MI), especially focusing on implementation of the recently proposed criteria by the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) for the definition of MI.


METHODS
A survey with questionnaires of the diagnostic approach was conducted among all relevant departments (220) in the Nordic countries.


RESULTS
Seventy-six percent (167) of hospitals responded. Troponins I and T (TnI and TnT) and creatinine kinase monobasic fraction (mass concentration) (CKMB(mass)) covered 93 and 65% of hospitals, respectively. Of troponin users, 34% indicated use of TnI vs 66% using TnT. Sporadic use of AST, CK, LD and myoglobin was reported. There was a tendency to lower cut-off levels in Sweden and Finland. Among troponin assays, there was considerable heterogeneity regarding cut-off levels.


CONCLUSIONS
The Nordic countries are approaching ESC/ACC consensus on cardiac markers. Compared with previous national surveys (1995-1999), there is a shift towards the use of troponins. However, differences in cut-off levels of troponin emphasize the need for harmonization of assays.
Hjortshøj
Søren
S
Cardiovascular Research Center and Department of Cardiology, Aalborg Hospital, Denmark.
Otterstad
Jan Erik
JE
Lindahl
Bertil
B
Danielsen
Ragnar
R
Pulkki
Kari
K
Ravkilde
Jan
J
D015415:Biomarkers; D019411:Clinical Laboratory Techniques; D032921:Consensus; D003718:Denmark; D004636:Emergency Service, Hospital / Q000592:standards*; D005387:Finland; D019538:Health Care Surveys; D006801:Humans; D007055:Iceland; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology; D009664:Norway; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D013548:Sweden
D015415:Biomarkers