Raccomandazione del Gds-MM siPMeL sul turnaround time per la troponina: aggiornamento 2024

Background: The Working Group on Myocardial Markers of the Italian Society for Clinical Pathology and Laboratory Medicine (GdS-MM SIPMeL) issued a Recommendation on the Turnaround Time (TAT) for troponin (cTn) in 2018: “The TAT of troponin, as the time from the sampling to the delivery of the report, must be as soon as possible with the maximum target of 60 minutes and optimal of 30 minutes, anyhow agreed with the clinical users” (Class of Strength I, Level of Evidence B). The aim of the present research is to establish whether the Recommendation is still valid considering the evidence produced in the last five years. Methods: Non-systematic researches was carried out in PubMed and in the websites of the main Scientific Laboratory Societies for Clinical Guidelines (LG) and Laboratory Medicine Guidelines (LGLM) writing recommendations on cTn TAT in the last five years. Since the main argument in support of our 2018 Recommendation was the proposal of rapid algorithms for rule in / rule out of ACS/NSTEMI, a research was carried out in PubMed on their diffusion over the last five years. Lastly, a systematic review (SR) was been undertaken on PubMed, over the last five years, on how to improve cTn TAT to achieve the optimal response time. Results: The literature search highlighted five international guidelines on ACS/NSTEMI, three of which suggest directly (ESC 2020 and 2023) or indirectly (ACC/AHA 2021) that the cTn TAT should be less than 60 minutes. Bibliographic research and consultation of the main websites of Scientific Laboratory Societies did not return any Laboratory Medicine guideline specifications on TAT cTn in the last 5 years. The research in PubMed from 2020 to today returns four works on the 0/3 h algorithm, six on the 0/2 h algorithm, 23 on the 0/1 h algorithm (two works compare the three algorithms and one work compares 0/1 and 0/ 2 algorithms) and, finally, nine for the use of T0. These data confirm the progressive diffusion of rapid algorithms, in particular the 0/1 h one proposed by ESC (European Society of Cardiology). The SR on PubMed, restricted to the last five years, with the aim “which cTn TAT is indicated as a reference” did not highlight any works” and with the aim “how to improve the cTn TAT to achieve the optimal report time” allowed us to include 12 works, focused on organizational improvement according to total quality tools such as Lean Six Sigma and root causes analysis, with specific interventions (pre-hospital samples; barcodes, floor plans, double measurement cells, chemical analyzers and staff shifts) and with strategic organizational modifications such as implementation of TLA (total laboratory automation) or, vice versa, POCT (point-of-care testing) (N.=6). Conclusions: Taken together, the research on guidelines and laboratory medicine guidelines for ACS/NSTEMI in the last five years, the exponential diffusion of rapid algorithms (in particular ESC 0/1 h) in the practice of ED (Emergency Department) and, finally, SR on Troponin and TAT which highlight that the current research is aimed at ways to achieve the fastest cTn TAT rather than debating what the optimal cTn TAT is, confirm our 2018 research and conclusions on the topic and show that the goal of a cTn TAT of less than one hour is commonly accepted by the scientific community.