IMPACT OF THE ESCACC CONSENSUS REPORT ON RE-DEFINITION OF by armedman1

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IMPACT OF THE ESC/ACC CONSENSUS REPORT ON RE-DEFINITION OF
MYOCARDIAL INFARCTION IN THE NORDIC COUNTRIES
S Hjortshoj1 , JE Otterstad2, B Lindahl3, R Danielsen4, K Pulkki5, J Ravkilde6
1
  Dept. of Cardiology, Aalborg Hospital – Aarhus University Hospital, Denmark,
2
  Division of Cardiology Vestfold Central Hospital, Toensberg, Norway, 3Uppsala
Clinical Research Center (UCR) and Dept. of Cardiology, Uppsala, Sweden, 4Hjartadeild
Landspitala Hringbraut, Reykjavik, Iceland, 5Laboratory Division, Helsinki University
Central Hospital, Helsinki, Finland, 6Dept. of Cardiology, Skejby Hospital – Aarhus
University Hospital, Denmark

In year 2000, the European Society of Cardiology (ESC) and the American College of
Cardiology (ACC) published a consensus report on diagnosis of myocardial infarction
(MI). We evaluated the possible impact of the report on the use of cardiac markers in the
Nordic countries. Questionnaires on types of cardiac markers, assays, and cut-off values
for MI were distributed to all relevant departments (N=220) in Denmark, Finland,
Iceland, Norway, and Sweden. Seventy-six percent (N=167) was returned. Cardiac
troponins I and T (TnI and TnT) and CKMB mass concentration were the predominant
markers, covering 93 % vs. 65 % of all hospitals. Among troponin-users, 34 % reported
use of TnI vs. 66 % using TnT. Older markers (AST, LD, and CK) were used only
sporadically (0.6-6 %). There was a tendency to lower cut-off values in Finland and
Sweden. Nine different assays of TnI were used as compared to one assay of TnT. For
some assays, several cut-off values were reported. Previous surveys in Denmark (1999),
Norway (1995), and Sweden (1998) showed troponin-use in 29 %, 3.5 %, and 53 % of
hospitals, respectively. In year 2004, 93 % of all Nordic hospitals use troponin testing
(Denmark: 96 %; Finland: 100 %; Iceland: 83 %; Norway: 89 %; Sweden: 92 %). The
Nordic countries approach ESC/ACC consensus on cardiac markers. Compared with
national surveys (1995-1999), there is a clear shift towards use of troponins. However,
different cut-off levels for the same assays emphasize the need for harmonization
between institutions.

								
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