Authors' objectives:

To determine whether troponin testing is clinically and cost effective for the management of patients presenting with acute coronary syndromes and to consider how such a service could be optimally organised for Scotland.

Authors' results and conclusions: Due to its greater sensitivity and specificity for detecting myocardial damage, troponin should replace other cardiac enzyme tests (except creatine kinase for assessing early re-infarction). Troponin testing is most effectively used with other risk markers to inform diagnostic decisions and to assess risk and suitability for medical or invasive treatment, within the context of a protocol or scoring system. The timing and diagnostic value of troponin testing depend on clinical characteristics of patients which has led to several recommendations related to the optimal and appropriate timing of troponin testing. Both the economic modelling and clinical evidence show that substantial advantages may accrue from ensuring that the troponin test result is available at the earliest possible time at which a clinical decision can be made. The cost-effective use of troponin testing may also allow timely treatment of patients in most clinical need and the health service to benef! it from improved bed and drug utilisation. Patients expressed the need for more information about troponin testing and clarity in communicating a diagnosis. This HTA recommended troponin testing be available in all Scottish hospitals receiving patients with ACS, and sets out timings for the tests.

Authors' recommendations: As troponin testing is only one component of the patient pathway, other aspects of the process must be well constructed and supported by appropriate protocols and investment so that increasing the availability of troponin testing and reducing turnaround times can provide valuable benefits to patients in Scotland. There is also a need to agree a consistent definition of myocardial infarction to end diagnostic confusion.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.nhshealthquality.org/

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Scotland

Organisation Name: Quality Improvement Scotland

Contact Address: Delta House, 50 West Nile Street Glasgow G1 2NP Scotland United Kingdom Tel: +44 141 225 6988; Fax: +44 141 221 3262

Contact Name: shtg.hcis@nhs.net

Contact Email: shtg.hcis@nhs.net

Copyright: NHS Quality Improvement Scotland (NHS QIS)