Trends in Use of Biomarker Protocols for the Evaluation of Possible Myocardial Infarction

Conclusion: there is considerable variation in cardiac marker testing strategies used in us hospitals for evaluation of suspected acute myocardial infarction. although increasing,24% of hospitals used a ctn alone strategy,and only 49% used ctn at the recommended 99th percentile cut point. this has important implications for the diagnosis and treatment of patients with acute myocardial infarction.background: various combinations of creatine kinase-mb,myoglobin,and cardiac troponin i or t (ctni/ctnt) have been used to evaluate patients with suspected acute coronary syndromes. the current recommendation is to use the 99th percentile of ctni/ctnt as the sole marker for diagnosis of acute myocardial infarction.methods and results: we retrospectively analyzed cardiac marker protocols collected from 824 us hospitals undergoing chest pain center accreditation through the society of cardiovascular patient care from 2009 to 2014. data were obtained by a self-reported survey that addressed cardiac marker(s),sampling time periods,and cut points used for evaluation of suspected acute myocardial infarction. the combination of ctni or ctnt with creatine kinase-mb was the most commonly used biomarker strategy. use of ctni or ctnt as the sole marker increased over time (14-37%; p<0.0001),as did use of the 99th percentile cut point for ctni/ctnt (30-60%; p<0.0001). © 2017 the authors. published on behalf of the american heart association,inc.,by wiley.