The quality of laboratory aspects of troponin testing in clinical practice guidelines (CPGs) and consensus documents needs to be improved, finds a new study, published in Clinica Chimica Acta. As such, the European Federation of Laboratory Medicine (EFLM) and the Union of European Medical Specialists (UEMS) joint Working Group on guidelines developed a checklist in an effort to standardize how laboratory investigations in CPGs are described.
The authors examined CPGs or consensus documents published from 2011 to 2013 that describe investigating chest pain, diagnosis of acute coronary syndrome (ACS), or myocardial infarction (MI), and they also looked at cardiovascular societies’ websites to search for relevant publications. “The included papers were evaluated against the published checklist for the optimum description of tests in guidelines including the pre-analytical phase (test request and sampling), analytical phase (troponin measurement), and post-analytical phase (test reporting and interpretation),” according to the report. Nine consensus documents or international guidelines were included in this analysis, and the description of troponin testing was reviewed per the checklist.
The 2011-2013 timeframe was selected because “earlier guidelines are likely to be updated in the near future due to third universal definition of MI being published in 2012,” the authors explained. Guidelines that exclusively applied to treatment, such as revascularization or follow-up of already diagnosed ACS/MI, were excluded from this report.
“This study shows that CPGs and consensus documents give sometimes different and even conflicting information regarding the use of troponin analysis. Most of the laboratory-related items are not considered or need to be updated,” the authors conclude. “For the benefit of the patients and enhancement of the implementation of the universal definition of myocardial infarction, the description of troponin testing in CPGs should be improved. A closer cooperation between clinicians and laboratory specialists during guideline development is indeed warranted.”
Read the study online.