Improving the diagnosis of acute myocardial infarction in an African-descent population: Estimating national reference levels for Troponin-I in Barbados

Recent annual reports from Barbados’ national CVD surveillance system indicate poor outcomes for acute myocardial infarction (MI), a leading cause of Barbadian mortality. Diagnosis of acute MI encompasses a complex of cardiac biomarker and ECG results, in the presence of symptoms of cardiac ischemia. However, physicians in Barbados must rely on national reference levels for cardiac biomarkers which have been estimated from other, predominantly European-ancestry populations. The scientific literature indicates that the threshold levels for cardiac Troponins (cTn; currently the most sensitive cardiac biomarkers in use) may be different for African-ancestry populations.
This study aims to estimate, for the first time, national threshold levels for the predominantly African-descent Barbadian population using the two main commercial tests used by the Barbados Reference Lab (BRL) and the Queen Elizabeth Hospital (QEH), and for the point-of-care (POC) test kit used in the QEH Accident & Emergency Dept. Based on our results, these thresholds will be provided to the Barbadian healthcare sector for use with these test kits, so that diagnosis of acute MI in Barbados may improve in consistency and accuracy. By providing reference levels for more than one commercial test, objective alternative options will be available in case of supply changes in the future.