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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.
1.2 The tests are recommended for use with different early rule-out test strategies alongside clinical judgement, including:
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).
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.
|Cardiac Markers Programme|
|Analyte||Approx. Range Covered|
|hsTroponin I||1-1250||ng/L (Abbott Architect/ Alinity)|
|hsTroponin T||4-440||ng/L (Roche Elecsys)|
|Troponin T||<10-380||ng/L (AQT 90)|
|Troponin I||<10-1375||ng/L (iStat)|
|CK MB (activity)||0-180||IU/L (Vitros)|
|*CK MB (mass)||0-60||µg/L|
*these analytes are only available for the Quidel Triage Cardiac Panel.