Freedom of Information Request: 0003 2019/20
University Hospitals Birmingham NHS Foundation Trust (UHB) completed a merger by acquisition of Heart of England NHS Foundation Trust (HEFT) on 1st April 2018. Due to historical differences in data collection/reporting across UHB and the former Heart of England NHS Foundation Trust this response has been provided by hospital site.
Queen Elizabeth Hospital Birmingham
Do the hospitals within your Trust use High Sensitivity Troponin Assay to diagnose patients who present with suspected acute myocardial infarction (AMI)?
Yes
If yes, in which year was the High Sensitivity Troponin Assay introduced for this purpose?
2011
What assay is it (please specify manufacturer) and what threshold is used for a positive test?
hs-TnT is a patented Roche assay. Those labs not using Roche kit use high sensitivity troponin I (hs-TnI).
The biochemical criteria consistent with a positive diagnosis of an acute coronary syndrome is one hs troponin above the 99th centile for the normal population, and a change in the value of that troponin by at least 20% on a second blood sample taken 3 hours later. The 99th centile for hs-TnT is 14 ng/L.
For hs-TnI the 99th centile for females is 16 ng/L and for males 34 ng/L. The QEHB site will switch over to hs-TnI on May 6th 2019 having terminated our Roche contract.
Is it used for rapid rule-out of AMI to avoid hospital admission?
Yes.
Please send a copy of any guidelines or protocol used by your Trust for the diagnosis of AMI by email.
Please see attached ‘TherapeuticGuidelinesMyocardialInfarction’
Heartlands, Good Hope and Solihull Hospital
Do the hospitals within your Trust use High Sensitivity Troponin Assay to diagnose patients who present with suspected acute myocardial infarction (AMI)?
Yes.
If yes, in which year was the High Sensitivity Troponin Assay introduced for this purpose?
Labs have been running high sensitive Troponin since prior to 2014.
What assay is it (please specify manufacturer) and what threshold is used for a positive test?
| Abbott hs-Troponin I | |||||
| Abbott hs-Troponin I | 11 | ng/L | <34 | ||
| Male hs-TnI 99th percentile = 34 ng/L At least one hs-TnI result must be greater than or equal to 34 ng/L with a >20% change between serial measurements to be positive for AMI. |
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Is it used for rapid rule-out of AMI to avoid hospital admission?
Whilst the results will rule out an AMI, there are other risk stratification tools used, for example GRACE scores, if patients have a high GRACE score they might still be admitted due to coronary artery disease
Please send a copy of any guidelines or protocol used by your Trust for the diagnosis of AMI by email.
Please see attached ‘Management of ST Elevation Myocardial Infarction Guidelines’
TherapeuticGuidelinesMyocardialInfarction
Management of ST Elevation Myocardial Infarction Guidelines
