A pilot survey of the use and implementation of cardiac markers in acute coronary syndrome and heart failure across Europe. The CARdiac MArker Guideline Uptake in Europe (CARMAGUE) study

Clin Chem Lab Med. 2009;47(2):227-34. doi: 10.1515/CCLM.2009.044.


Background: Guidelines on preferred cardiac marker strategies for investigation of patients with acute coronary syndromes (ACS) are available from the laboratory medicine and cardiology communities. Therefore, implementation of these guidelines into daily clinical practice should be a joint effort of laboratory specialists and clinicians. This was investigated in this survey.

Methods: A pilot study was performed sponsored by the European Federation of Clinical Chemistry and Laboratory Medicine. A link to an online questionnaire was e-mailed to 990 laboratories from eight European countries in May 2006. The requested information included tests performed, clinical protocol development, and reference limits.

Results: We obtained a total of 220 responses. Out of these, 208 responses (95%) were from hospitals that provide 24-h admission of patients. The suggested turn-around-time (<60 min) was apparently met by >88% for cardiac troponin T/I and for CK-MB mass. The majority of the laboratories derive their decision limits from kit inserts provided by the manufacturers. The results revealed a worrying fact that external quality assessments are not used in all testing.

Conclusions: Our survey demonstrated that cardiac troponin is the preferred biomarker for the diagnosis of ACS. Half of the participants had written protocols, mostly as a result of collaboration between laboratorians and clinicians.

MeSH terms

  • Acute Coronary Syndrome / blood*
  • Biomarkers / blood
  • Clinical Laboratory Techniques / standards
  • Europe
  • Heart Failure / blood*
  • Humans
  • Pilot Projects
  • Practice Guidelines as Topic*


  • Biomarkers