New diagnostic guidance from the National Institute for Health and Care Excellence recommends the use of high-sensitivity troponin tests alongside an early rule-out protocol to speed up the assessment process for around 700,000 people attending A&E every year with chest pain and suspected acute coronary syndrome (ACS).
This guidance should benefit around 300,000 people presenting with suspected AMI each year that do not show the characteristic ECG findings associated with ST-segment-elevation MI (STEMI) and need further tests to establish the cause of their chest pain.
Damage to heart muscle cells caused by reduced blood flow during an MI leads to the release of cardiac troponin and changes in troponin levels can, therefore, help distinguish NSTEMI from unstable angina. Unfortunately assessment protocols for standard troponin tests takes 10–12 hours, meaning a prolonged stay in hospital for patients under assessment, causing unnecessary anxiety, and potentially delaying treatment decisions.
This positive move will greatly help to alleviate the burden on the NHS and to reduce the inconvenience and risks associated with unnecessary hospital admissions
The Elecsys Troponin T hs assay from Roche is up to 100 times more sensitive than standard troponin tests. Data suggests that it could accurately rule out NSTEMI in 60% of people presenting with chest pain in A&E within one hour. This means the majority of patients could avoid the need for prolonged monitoring. Early diagnosis using high-sensitivity troponin assays could save NHS England over £200 per patient by limiting unnecessary admissions.
Consultants at Manchester Royal Infirmary have already seen the value that the Elecsys high-sensitive cardiac troponin T assay delivers in helping speed up the diagnosis of AMI.
Dr Richard Body, A National Institute for Health Research (NIHR) postdoctoral research fellow and consultant in emergency medicine and honorary lecturer in cardiovascular medicine at Manchester Royal Infirmary, said: "Today, we have a clear and urgent problem with the diagnosis of non-ST elevation myocardial infarction in the emergency department. Patients are routinely admitted to hospital for serial biomarker testing even though only a minority actually has the diagnosis we suspect. In Manchester, high-sensitivity troponin assays have enabled us to identify patients with non-ST elevation myocardial infarction much earlier and much better than ever before.
“The new NICE recommendations provide practical guidance to clinicians that will help to reduce the duration of serial testing in a safe and cost-effective manner. This positive move will greatly help to alleviate the burden on the NHS and to reduce the inconvenience and risks associated with unnecessary hospital admissions."