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January 14, 2019
High-sensitivity cardiac troponin (hs-cTn) testing is new to the United States, but Canada, Europe, Australia, and New Zealand have been troubleshooting, problem-solving, and accruing evidence on these assays now for years. In today’s afternoon symposium, “High-Sensitivity Cardiac Troponin: As with Every New Tool, There is a Learning Curve,” attendees will hear from clinical trial emergency medicine physicians who paved the way for this testing in each of the four regions. These knowledgeable practitioners will debate current standards and cutting-edge practices in their regions, share their hard-won insights, and incidentally offer the audience a wealth of implementation knowledge.
The European Society of Cardiology (ESC) recently released new guidelines to rule-in and rule-out acute myocardial infarction (AMI) in the emergency department (ED) that have generated some controversy and much confusion about the appropriate use of hs-cTn in managing chest pain patients in the ED. This controversy will play out in the session with a formal debate between Richard Body, MB ChB, MRCSEd(A&E), FCEM, PhD, of Manchester Royal Infirmary in England and Martin Than, MBBS, of Christchurch Public Hospital in New Zealand.
Body and Than plan a two-part session. Part 1 will be a debate around the ESC guidelines and will tackle such questions as: Can we rule-out AMI with one test? What about within 2 hours? Part 2 will focus on answering the audience’s questions. Some of the issues Body and Than anticipate discussing include sex/age-specific cutoffs, the ED clinician’s perspective on laboratory accuracy, and early discharge of patients when using hs-cTn tests. The concerns over these new guidelines and hs-cTn testing are complex, and understanding the limitations of current viewpoints gained in this debate will be invaluable to attendees. Audience participation via FXP|Touch, a mobile-device-based audience response and engagement system that AACC is offering for the first time, is anticipated and rebuttals promise to be lively.
Body and Than will be joined by colleagues Peter Hickman, MBBS, PhD, FRCPA MHA, from ACT Pathology in Canberra, Australia, and Pete Kavsak, PhD, from McMaster University and Juravinski Hospital and Cancer Centre in Hamilton, Canada.
Hickman will discuss problems with hs-cTn 99th percentile cutoffs. Subtleties that previously were background noise in hs-cTn assays now have broken out of the fray and can affect appropriate reference range studies. Hickman plans to walk the audience through the appropriate approaches for deriving a 99th percentile cutoff and provide insight into the variety of reported 99th percentile cutoffs.
A leader in clinical studies and clinician education for hs-cTn assays, Kavsak will share daily practice issues for laboratory directors and an approach to implementing hs-cTn assays. He plans to cover pre-analytical, analytical, and post-analytical issues that affect hs-cTn results and interpretation including interferents, analytical variation, and other troubleshooting techniques. Case study vignettes will help the audience understand the context in which many of these issues occur and how to effectively troubleshoot and communicate with clinicians.
The session promises to end strong with what appears to be a speed-dating round in which Body, Than, and Kavsak will present new approaches for ruling-in and ruling-out AMI in the ED, in an effort to win over the audience’s votes for the best, next approach for early decision-making in the ED using hs-cTn assays.
This session provides insights from clinical and laboratory world leaders in hs-cTn testing and aims to provide the audience a deep understanding about these assays, their implementation and interpretation, as well as existing and emerging guidelines and the latest research.
Please find the original article in https://www.aacc.org/publications/cln/cln-daily/2017/high-sensitivity-cardiac-troponin-across-three-continents