title: How Well Do Laboratories Adhere to Recommended Clinical Guidelines for the Management of Myocardial Infarction: The CARdiac MArker Guidelines Uptake in Europe Study (CARMAGUE).
abstract: We undertook an assessment of current use of evidence-based guidelines for the use of cardiac biomarkers in Europe (EU) and North America (NA).
  
  
  
  In 2013-2014 a web-based questionnaire was distributed via NA and EU biochemical societies. Questions covered cardiac biomarkers measured, analytical methods used, decision thresholds, and use of decision-making protocols. Results were collated using a central database and analyzed using comparative and descriptive nonparametric statistics.
  
  
  
  In EU, returns were obtained from 442 hospitals, 50% central or university hospitals, and 39% from local hospitals from 35 countries with 395/442 (89%) provided an acute service. In NA there were 91 responses (63.7% central or university hospitals, 19.8% community hospitals) with 76/91 (83.5%) providing an acute service. Cardiac troponin was the preferred cardiac biomarker in 99.5% (EU) and 98.7% (NA), and the first line marker in 97.7% (EU) and 97.4% (NA). There were important differences in the choice of decision limits and their derivations. The origin of the information was also significantly different, with EU vs NA as follows: package insert, 61.9% vs 40%; publications, 17.1% vs 15.0%; local clinical or analytical validation choice, 21.0% vs 45.0%; P = 0.0003.
  
  
  
  There are significant differences between EU and NA use of cardiac biomarkers. This probably relates to different availability of assays between EU and NA (such as high-sensitivity troponin assays) and different laboratory practices on assay introduction (greater local evaluation of assay performance occurred in NA).
authors.affiliation: Departments of Chemical Pathology and Cardiology, St George's Hospital, London, UK; paul.collinson@stgeorges.nhs.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Collinson
authors.affiliation: Kantonspital Aarau AG, Aarau, Switzerland;
authors.forename: Angelika
authors.initials: A
authors.lastname: Hammerer-Lercher
authors.affiliation: HUSLAB, Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland;
authors.forename: Janne
authors.initials: J
authors.lastname: Suvisaari
authors.affiliation: Departments of Laboratory Medicine and Pathology, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN;
authors.forename: Fred S
authors.initials: FS
authors.lastname: Apple
authors.affiliation: University of Maryland School of Medicine, Baltimore, MD;
authors.forename: Rob H
authors.initials: RH
authors.lastname: Christenson
authors.affiliation: University of Eastern Finland and Eastern Finland Laboratory Centre, Kuopio, Finland;
authors.forename: Kari
authors.initials: K
authors.lastname: Pulkki
authors.affiliation: Maastricht University Medical Center, Maastricht, the Netherlands;
authors.forename: Marja P
authors.initials: MP
authors.lastname: van Dieijen-Visser
authors.affiliation: Department of Clinical Biochemistry, University Hospitals of North Midlands, Stoke-on-Trent, UK;
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Duff
authors.affiliation: Regionale Kliniken Holding RKH GmbH, Ludwigsburg, Germany;
authors.forename: Hannsjörg
authors.initials: H
authors.lastname: Baum
authors.affiliation: DIU Libertas International University, Zagreb, Croatia;
authors.forename: Ana
authors.initials: A
authors.lastname: Stavljenic-Rukavina
authors.affiliation: Haukeland University Hospital, Bergen, Norway;
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Aakre
authors.affiliation: Asklepios Core-lab, Department of Laboratory Medicine, AZ St-Jan Hospital Bruges and Ghent University, Ghent, Belgium;
authors.forename: Michel R
authors.initials: MR
authors.lastname: Langlois
authors.affiliation: Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Sanja
authors.initials: S
authors.lastname: Stankovic
authors.affiliation: HUSLAB, Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland;
authors.forename: Paivi
authors.initials: P
authors.lastname: Laitinen
mesh_terms: D015415:Biomarkers / Q000032:analysis; D019411:Clinical Laboratory Techniques; D005060:Europe; D055317:Evidence-Based Practice; D019983:Guideline Adherence; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis*; D009656:North America; D014336:Troponin / Q000032:analysis*
chemical_list: D015415:Biomarkers; D014336:Troponin