03.23.2022
We are excited to be implementing the high-sensitivity troponin (hs-TnI) lab assay across the Munson Healthcare system. Here are some vital things to know:
- Timing: The hs-TnI will replace our current troponin lab assay across the entire Munson Healthcare system on April 12, 2022
- Interpretation: The new hs-TnI assay is able to accurately measure a Tn level in most patients which eliminates the concept of a “negative” troponin.
- Because a hs-TnI level can be measured in most patients, the focus is now on the change, or “delta”, of hs-TnI over a specified time interval.
- The new assay allows over 2/3 of patients presenting with chest pain/chest pain equivalents to be categorized into low or high risk within 2 hours.
- The 99th percentile upper range limit (URL) for the MHC hs-TnI assay is 18 ng/L. Values above this level indicate myocardial injury but NOT the mechanism of that injury.
- Myocardial injury can be ischemic vs non-ischemic and acute vs chronic. Integration of the hs-Tn I level with other clinical findings is crucial in determining the cause of the myocardial injury and appropriate treatment strategies.
- Safety: High sensitivity Tn testing has been used in Europe for over a decade and there is a robust literature supporting its utility in clinical decision making. The assay was recently approved in the US and major medical centers across the country have been moving to this form of testing.
- Ordering: For Cerner PowerChart, the new hs-Tn I powerplan order will have 0 hr, 2hr and 4 hr draws prechecked. The 4 hr draw may be cancelled if the clinical situation does not warrant ongoing testing. A single hs-Tn I will be orderable but should rarely be used given the limited value of a single hs-Tn I level in clinical management.
Please visit the MHC High Sensitivity Troponin Implementation resource website for more information about this change, including links to educational resources and the care algorithm.