Cardiac Markers

Cardiac Markers

Immunoassay parameters are provided in the following programmes: Endocrine, Haematinics, Cardiac Markers, BNP and NT-ProBNP.

Purpose:
The Programme aims to assess the performance of organisations utilising biochemical cardiac markers to aid in the diagnosis of acute coronary syndrome (ACS) and cardiac ischaemia. High sensitivity cardiac Troponin T and I have replaced standard Troponin assays, myoglobin and Creatine kinase – MB as the preferred markers of myocardial injury. NICE diagnostic guidance – [DG40], High sensitivity troponin tests for the early rule out of NSTEMI, published in August 2020  recommended a number of hsTroponin methods that could be used for the early rule out of non-ST-segment elevation myocardial infarction (NSTEMI) in people presenting to an emergency department with chest pain and suspected acute coronary syndrome.

NICE Guidance DG40 Recommendations

1.2          The tests are recommended for use with different early rule-out test strategies alongside clinical judgement, including:

  • A single sample on presentation using a threshold at or near the limit of detection, which will vary depending on the assay being used. If this sample is positive it should not be used to rule in NSTEMI.
  • Multiple sample strategies, which typically include a sample at initial assessment followed by a second sample taken at 30 minutes to 3 hours (if clinically appropriate) and use of 99th percentile thresholds or thresholds at or near the limit of detection of the assay. Healthcare professionals should consider the likely time since the onset of symptoms when interpreting test results.

1.3          When NSTEMI is not ruled out using early rule-out test strategies, use NICE’s guideline on recent -onset chest pain of suspected cardiac origin, [CG95] to help diagnose myocardial infarction, and consider using sex-specific thresholds at the 99th percentile (see section 4.7 and section 5.2).

Scope:
The Weqas Cardiac markers EQA programme is available as serum or plasma based samples, participants can select the programme most appropriate for their analyser. Four liquid human serum samples are distributed monthly, with a minimum of 48 samples distributed over the year covering a wide clinical range.  The samples consist of endogenous samples from patients along with a panel of linearly related samples produced from donations from healthy volunteers spiked with Cardiac Troponin.

The programme includes samples at clinically relevant ranges at or near the threshold or limit of detection and samples at the 99th centile thresholds for hs Troponin.   The programme also accommodates Point of care (POCT) Troponin assays as well as those offering semi-quantitative reporting of Troponin.  They are distributed on a number of occasions over the year which allows for the assessment of the organisation’s and method’s performance, including linearity, bias, within and between batch imprecision.


Key Features:

  • Includes challenging samples at limits of detection and diagnostic “99th centile” for hs TnT and Tnl.
  • Allows semi-quantitative reporting for PoCT Tn.
  • Liquid human serum samples require no pre-analytical preparation.
  • Linearly related panel covering a clinically relevant range.

Frequency:
Monthly
Samples:
4 x 1.0mL
Material:
Off the clot human serum
Cardiac Markers Programme
AnalyteApprox. Range Covered
hsTroponin I1-1250 ng/L (Abbott Architect/ Alinity)
hsTroponin T4-440 ng/L (Roche Elecsys)
Troponin T<10-380 ng/L (AQT 90)
Troponin I<10-1375 ng/L (iStat)
CK MB (activity)0-180IU/L (Vitros)
*CK MB (mass)0-60 µg/L
*Myoglobin 14-500 µg/L

*these analytes are only available for the Quidel Triage Cardiac Panel.

Related Documents

Browse all Laboratory EQA Programmes

Accreditation

UKAS Proficiency Testing 4301UKAS Calibration 4301


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