Fast track protocols using highly sensitive troponin assays for ruling out and ruling in non-ST elevation acute coronary syndrome.
The introduction of "highly sensitive" cardiac troponin assays (hsTn) has reinforced the evidence that only serial testing incorporated in running algorithms allows a more accurate diagnosis of acute myocardial infarction. In this report, we consider the available evidence supporting the use of fast track protocols for ruling out and ruling in non-ST elevation myocardial infarction (NSTEMI) and compare it with the content of recently released guideline by the European Society of Cardiology, noting some uncomfortable aspects that need urgent clarification and/or revision. Firstly, the guideline drafters have to reconsider the available evidence that does not permit to assign the same class and level of evidence to the very well-validated 0-3 h algorithm and to the 0-1 h algorithm. In agreement with the validity of available data, the limitations of fast track protocols, in particular of the 0-1 h algorithm for NSTEMI rule-in, calls for caution. Secondly, as the current diagnostics guidance by the UK National Institute for Health and Care Excellence recommends, rapid diagnostic protocols should be performed only using well-validated hsTn; recommending the use of an assay before being commercially available is not fair and scientifically sound.
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Simona
S
Ferraro
.
Alberto
A
Dolci
.
Mauro
M
Panteghini
D000465:Algorithms; D001681:Biological Assay; D016001:Confidence Intervals; D004636:Emergency Service, Hospital; D006801:Humans; D057230:Limit of Detection; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis*; D013997:Time Factors; D014336:Troponin / Q000032:analysis*
D014336:Troponin
non-ST elevation acute coronary syndrome; rule in; rule out; troponin