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La Rivista Italiana della Medicina di Laboratorio 2021 Giugno;17(2):75-81

DOI: 10.23736/S1825-859X.21.00099-2


language: Italian

Rapid algorithms for NSTEMI between clinical needs and critical diagnostic issues

Marco MORETTI 1 , Alessio GAMBONI 2, Piero CAPPELLETTI 3, Maria A. BURGIO 4, Massimiliano MANNO 5, Elisabetta STENNER 6, Francesca VENEZIANI 7, Lucia MALLOGGI 8, Margherita MORANDINI 9, Giulio MARINO 10, Martina DI PIETRO 11, Deborah MAZZEI 8, Jessica VIOLA 12, Dina DI MARIA 13, Daniela RUBIN 14, Matteo CASSIN 15, Gianni A. GALLI 16, Gruppo di Studio sui Marcatori Miocardici (GdS MM) della Società Italiana di Patologia Clinica e Medicina di Laboratorio (SIPMeL)

1 Medicina di Laboratorio, AOU Ospedali Riuniti, Ancona, Italia; 2 Medicina d’Urgenza ASL2, Foligno, Perugia, Italia; 3 SIPMeL, Castelfranco Veneto, Treviso, Italia; 4 Patologia Clinica, Ospedale Barone Lombardo, Canicattì, Agrigento, Italia; 5 Laboratorio Analisi, Città di Lecce Hospital-GVM Care&Research, Lecce, Italia; 6 Laboratorio Analisi Chimico Cliniche, Ambito Territoriale Livorno, Azienda USL Toscana Nordovest, Livorno, Italia; 7 SOS Laboratorio Analisi, Ospedale S. Maria Nuova, USL Centro Toscana, Firenze, Italia; 8 Laboratorio Analisi, AOU, Pisa, Italia; 9 Laboratorio Analisi, ASFO, Pordenone, Italia; 10 Laboratorio Analisi, AUSL Bologna, Vergato, Bologna, Italia; 11 Laboratorio Unico Metropolitano, AUSL, Bologna, Italia; 12 Patologia Clinica, Asp 4, Enna, Italia; 13 Laboratorio Analisi, Polimedica, Ravanusa, Agrigento, Italia; 14 Laboratorio Analisi, AULSS2, Conegliano Veneto, Treviso, Italia; 15 Cardiologia, Casa di Cura San Giorgio, Pordenone, Italia; 16 Fondazione Estote Misericordes, Borgo San Lorenzo, Firenze, Italia

Chest pain is a complex health problem, and it has been a clinical challenge for a long time due to the absolute number of visits to Emergency Department and its potential risk for patient. The availability of high-sensitivity troponin assays (hs-cTn) and clinical risk stratification scores have led to the adoption of accelerated diagnostic pathways with promising results in terms of diagnostic timeliness and rule-in/rule-out strategy of patients affected by acute coronary syndrome (ACS). The care pathways proposed by the recent ESC 2020 document confirm the pivotal role of high sensitivity Troponin assays undertaking a digitization process in the diagnosis of ACS and more generally of myocardial injury detection. The decision-making burden is shifted to Laboratory Medicine, which is responsible for the reliability and limits of different assays. From this point of view, a critical review of the literature is mandatory, starting with ESC 2020 report, to understand its feasible application in the real life. The task of Laboratory Medicine is to ensure analytically reliable dosages and their timeliness for rule-in and rule-out of a time dependent pathology (ACS). In this review, the main issues regarding the feasibility of rapid algorithms based on the hs-cTn assay will be addressed: 1) evaluation of the total analytic error (TAE); 2) quality assurance (internal quality control in the series, between series, between batches and between instruments); 3) impact of intra-individual biological variability; and 4) compliance with the turnaround times (TAT) required by the suggested algorithms.

KEY WORDS: Troponin; Trans-crotonin; Acute coronary syndrome; NST non-ST elevated myocardial infarction EMI

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