Il tempo di risposta del Laboratorio (turnaround time, TAT) per la troponina (cTn). Raccomandazione del GdS MM SIPMeL

Edizioni Minerva Medica - Tập 14 - Trang 105-121 - 2018
Daniela Rubin1, Matteo Cassin2, Margherita Morandini3, Piero Cappelletti4, Francesca Veneziani5, Maria Aurora Burgio6, Massimiliano Manno7, Elisabetta Stenner8, Marco Moretti9, Giulio Marino10, Dina Di Maria11, Deborah Mazzei12, Lucia Malloggi12, Alessio Gamboni13, Gianni Antonio Galli14
1Laboratorio Analisi AULSS2, Conegliano, Italia
2Cardiologia, AAS5, Pordenone, Italia
3Laboratorio Analisi, AAS5, Pordenone, Italia
4SIPMeL, Castelfranco, Italia
5Laboratorio Analisi, Ospedale S. Maria Nuova, USL Centro Toscana, Firenze, Italia
6Patologia Clinica Ospedale Barone Lombardo, Canicattì, Italia
7Laboratorio Analisi, Città di Lecce Hospital-GVM Care&Research, Lecce, Italia
8Patologia Clinica, ASUITS, Trieste, Italia
9Patologia Clinica A.O. Ospedali Riuniti Marche Nord, Pesaro, Italia
10Laboratorio Analisi, AUSL Bologna, Vergato, Italia
11Laboratorio Analisi Polimedica, Ravanusa, Italia
12Laboratorio Analisi, AOU, Pisa, Italia
13Medicina d’Urgenza ASL2, Foligno, Italia
14Estote Misericordes, Firenze, Italia

Tóm tắt

La tempestività della risposta della troponina (cTn), misurata come turnaround time (TAT), è critica nella diagnostica della sindrome coronarica acuta (SCA), ma tradizionalmente deve tenere conto della necessità di prelievi multipli con tempistiche definite dalle linee guida. Lo scopo del lavoro è la valutazione della letteratura dal 2013 a oggi nella definizione del TAT di cTn necessario nella diagnosi di SCA nel Dipartimento di Emergenza (DE). È stata condotta una ricerca bibliografica in PubMed e in siti istituzionali e di Società scientifiche per verificare, nell’arco degli ultimi 5 anni, se le linee guida cliniche e di laboratorio che affrontano la diagnosi di SCA definiscano raccomandazioni concernenti TAT di cTn e se sono emerse prove di efficacia, dirette o indirette, degli effetti di TAT cTn sugli esiti clinici e/o organizzativi dei pazienti in DE. Tre su otto linee guida cliniche e cinque su cinque linee guida di laboratorio, così selezionate, convergono nell’indicazione di un TAT di cTn di 1 ora (1 h) o inferiore, che però non si basa su “evidenze” certe del suo effetto sugli esiti organizzativi e/o clinici se non sulla permanenza (length-of-stay, LOS) in DE, che peraltro può produrre effetti negativi sugli outcome del paziente. Tuttavia, la diffusione degli algoritmi diagnostici con troponina ad alta sensibilità (high sensitivity troponin, hs-cTn) per il rule in/rule out di SCA sempre più veloci a 1 h, 30 min e all’ingresso (T0) e di protocolli (accelerated diagnostic pathways, ADP), che di solito contemplano anche ECG e valutazioni del rischio (risk score), permette una decisione clinica in 1 ora per oltre i due terzi e al tempo zero in oltre un terzo dei pazienti presenti in DE con sospetto NSTEMI (non-ST elevation myocardial infarction) in sicurezza (NPV per eventi avversi 98,7–100% e 95,5–100%, rispettivamente). Esiste, però, una discrepanza nell’esatta definizione del TAT di cTn, in particolare del punto di partenza (richiesta, prelievo, arrivo in Laboratorio). Si raccomanda che il TAT di hs-cTn sia inferiore all’ora per rispondere agli algoritmi diagnostici proposti e sia definito identificando il punto di partenza nel prelievo, secondo le linee guida valide ormai da quasi vent’anni.

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