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Given how tough it has been to get physicians to stop ordering creatine kinase-myocardial band (CK-MB) tests for suspected acute coronary syndrome (ACS), academic physicians created guidance on the institutional elimination of this practice.

Jeffrey C. Trost, MD, of Johns Hopkins University School of Medicine in Baltimore, and collaborators in the High Value Practice Academic Alliance (a group comprising members from more than 80 academic medical centers) recommended in that institutions:

1. Design and implement a hospital-wide educational campaign on the use of CK-MB versus troponin testing

2. Remove CK-MB from standardized ACS routine order sets by partnering with information technology or laboratory medicine staff or both

3. With the same staff, create and integrate a best practice alert -- a reminder that troponin is the preferred biomarker -- into computerized physician order entry to appear when clinicians order CK-MB

4. Before and after intervention, keep track of data such as the number of CK-MB and troponin tests ordered and patient outcomes after acute MI

"Though seemingly straightforward to articulate, we acknowledge that significant barriers to implementation exist, and in this case the biggest hurdle has been convincing physicians who have ordered CK-MB for years to change their practice," Trost's group said.

"Since the 2000 American College of Cardiology/European Society of Cardiology redefinition of acute MI, which was revised into the 2007 and 2012 Universal Definition of acute MI, cardiac troponin has been the biomarker of choice owing to its nearly absolute myocardial tissue specificity and high clinical sensitivity for myocardial injury."

"Next-generation" (high-sensitivity) troponin testing was cleared by the FDA earlier this year.

Many clinicians continue to ignore the evidence supporting troponin as the preferred biomarker, the authors wrote, even after the release of evidence-based guidelines such as those from the 2014 American Heart Association/American College of Cardiology giving CK-MB testing a class III, level of evidence A recommendation.

Eliminating these tests can save millions annually without harm to patients, they emphasized.

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