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New heart tests speed up NSTEMI diagnosis, says NICE

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New tests should be introduced to drastically reduce the time it takes to diagnose heart attacks, according to the National Institute for Health and Care Excellence.

The two tests measure the levels of cardiac troponin, a protein that is released into the blood when the heart muscle is damaged, often as the result of a heart attack.

“The increased sensitivity of these tests could mean a reduced length of stay for people without raised levels of troponin”

Carole Longson

Standard tests for cardiac troponin are most accurate when carried out between 10 and 12 hours after the onset of symptoms of a heart attack.

Under current methods, two tests are performed to detect any change in troponin levels, which means many patients have to be admitted for observation while the testing is carried out.

But the two new “high-sensitivity” tests can detect lower levels of troponin in the blood than the previous tests, helping clinicians diagnose or rule out a heart attack or other cardiac conditions much quicker.

NICE has published draft guidance recommending the use of the two tests and a final decision is expected in October.

Professor Carole Longson, director of NICE’s health technology evaluation centre, said that use of the high-sensitivity tests would enable the earlier detection of changes in troponin levels.

She said: “This in turn can allow doctors to rule out a diagnosis of a specific type of heart attack called a non-ST-segment elevation myocardial infarction (NSTEMI) within four hours, if test results are available within three hours of presentation to the emergency department.

Professor Carole Longson

Professor Carole Longson

“The increased sensitivity of these tests could mean a reduced length of stay for people without raised levels of troponin, and earlier treatment for those with a confirmed NSTEMI.”

The new tests would be used alongside traditional electrocardiogram (ECG) tests and an evaluation of a patient’s clinical history to diagnose an NSTEMI, because cardiac troponin levels can also be raised in people who do not have coronary heart disease.

Conditions which may cause cardiac troponin levels to be raised include myocarditis, severe infections, and renal disease.

Around 700,000 people go to hospital ever year in England and Wales because of chest pain, according to NICE, while in 2011-12 some 79,433 people were admitted with a heart attack or unstable angina.


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Readers' comments (1)

  • My trust is already using this on a 3 hour apart testing regime but the delay in sample taking and lab processing times together with inappropriate testing, 'troponinitis' still mean many chest pain patient's are admitted that could be discharged from the ED if the process were streamlined.

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