Stato dell’arte dei marcatori cardiaci in Italia: la III indagine del GdS MM SIMeL View Full Text


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Article Info

DATE

2014-10-10

AUTHORS

Piero Cappelletti, Gianni Antonio Galli, Lucia Malloggi, Elisabetta Stenner, Marco Moretti, Margherita Morandini, Daniela Rubin, Matteo Cassin

ABSTRACT

A survey on the use of cardiac markers in Italy was made by Working Group on Cardiac Markers of Italian Society for Laboratory Medicine (GdS MM SIMeL) in 2013. 126 colleagues answered a 47-items Questionnaire. Moreover, 2 subgroups were studied: Group A—laboratories without Cardiac Care Unit (CCU) n. 36; and Group B—laboratories serving CCU n. 90.Conflicting results were obtained from this study in a real-world environment.Encouraging results were: 100% of the Laboratories used troponin (cTn) as the preferred marker for routine diagnosis of suspected acute coronary syndromes (ACS) and up to 50% used only cTn; up to 80% in Group B Laboratories accepted and used international guidelines; 100% of the Laboratories in Group B run QC and 92% EQA; there were no proliferation of cardiac markers without scientific evidence but a wide use (70%; 87% in Group B) of Cardiac Natriuretic Peptides (CNP) with a good level of quality assurance (QC and EQA); POCT (Point-of-care testing) devices were calibrated (70%), controlled (QC 97%), and under laboratory supervision (90%).Main concerns were: 25% of the Laboratories did not accept international guidelines and 45% lacked of agreed protocols; 50% used combined cTn measurement with another marker (8% with obsolete markers); 30% used serum, in spite of its negative effect on TAT (Turnaround Time); <50% measured TAT and 78% showed an insufficient knowledge about the importance of the tool for efficacy, quality and communication of the Laboratory; 40% of the Laboratories did not use decision limit (DL) and 60% did not use reference levels (RL); Laboratories that choose DL or RL used manufacturers’ data for the reference intervals and decision limits (50 and 60%, respectively) and only 20% in Group B provided independent and customized cut-offs; only 30% POCT devices used the same method for troponin used in the Central Laboratory.There were same problems about TAT and DL/RL for Cardiac Natriuretic Peptides, highlighting a cultural deficit, mainly for laboratories of first diagnostic line (Group A), that should become more confusing with the advent of high-sensitivity troponin methods and should be a main issue for educational activity of SIMeL and its GdS MM.The survey showed that analytic quality (method, sample, QC, EQA, TAT), interpretation (guidelines; DL and RL), clinic-laboratory interface work (protocols; TAT, patients selection and results application of collaborative research) are not isolated issues, because they are interrelated steps for a good answer to the clinical needs. More... »

PAGES

212-223

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http://scigraph.springernature.com/pub.10.1007/s13631-014-0069-8

DOI

http://dx.doi.org/10.1007/s13631-014-0069-8

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https://app.dimensions.ai/details/publication/pub.1028451906


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