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Impact of High-Sensitivity Cardiac Troponin Assay
Study Questions:
What is the clinical impact of adopting a higher sensitivity troponin assay in routine practice?
Methods:
The investigators compared the clinical outcomes and resource utilization in the SWEDEHEART (The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) registry 1 year before and after the introduction of the high-sensitivity troponin assays.
Results:
The authors assessed data from 47 Swedish hospitals that introduced the new assay. There was an increase in use of echocardiography (from 48% to 52%) and coronary angiography (44% to 48%). In the second year, more at-risk patients were admitted and a cardiac troponin (cTn) level above the myocardial infarction cut-off was seen in a larger proportion of patients with both acute coronary syndrome (ACS) (+13.1%) and in patients with a diagnosis other than ACS (+160.1%). Patients with an elevated cTn level were at an increased risk of mortality in the second half of the study (adjusted hazard ratio [HR], 4.45; 95% confidence interval [CI], 3.36-5.89) compared with the initial study period (adjusted HR 2.43 [95% CI 2.11-2.80]), similar as for the cTn ratio relative to the respective 99th percentile.
Conclusions:
The introduction of a higher sensitivity troponin was associated with an increase in use of appropriate therapies in patients with elevated troponin levels.
Perspective:
The high-sensitivity troponin assays have the potential to markedly impact the clinical care of patients with chest pain. However, the high sensitivity of these tests also raises concerns about false positives, excessive investigation, and overuse of diagnostic testing. This study from Swedish coronary care units (ICUs) suggests that the use of these assays is associated with more appropriate care, but it is unclear how these assays will impact clinical care and resource utilization in the emergency room and in the non-CCU population when these assays become part of US medical practice.
Keywords: Acute Coronary Syndrome, Biomarkers, Chest Pain, Coronary Angiography, Coronary Care Units, Diagnostic Imaging, Echocardiography, Myocardial Infarction, Troponin
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