Impact of high-sensitivity cardiac troponin on use of coronary angiography, cardiac stress testing, and time to discharge in suspected acute myocardial infarction
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Impact of high-sensitivity cardiac troponin on use of coronary angiography, cardiac stress testing, and time to discharge in suspected acute myocardial infarction. / Twerenbold, Raphael; Jaeger, Cedric; Rubini Gimenez, Maria; Wildi, Karin; Reichlin, Tobias; Nestelberger, Thomas; Boeddinghaus, Jasper; Grimm, Karin; Puelacher, Christian; Moehring, Berit; Pretre, Gil; Schaerli, Nicolas; Campodarve, Isabel; Rentsch, Katharina; Steuer, Stephan; Osswald, Stefan; Mueller, Christian.
In: EUR HEART J, Vol. 37, No. 44, 21.11.2016, p. 3324-3332.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Impact of high-sensitivity cardiac troponin on use of coronary angiography, cardiac stress testing, and time to discharge in suspected acute myocardial infarction
AU - Twerenbold, Raphael
AU - Jaeger, Cedric
AU - Rubini Gimenez, Maria
AU - Wildi, Karin
AU - Reichlin, Tobias
AU - Nestelberger, Thomas
AU - Boeddinghaus, Jasper
AU - Grimm, Karin
AU - Puelacher, Christian
AU - Moehring, Berit
AU - Pretre, Gil
AU - Schaerli, Nicolas
AU - Campodarve, Isabel
AU - Rentsch, Katharina
AU - Steuer, Stephan
AU - Osswald, Stefan
AU - Mueller, Christian
N1 - © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2016/11/21
Y1 - 2016/11/21
N2 - AIMS: High-sensitivity cardiac troponin (hs-cTn) assays provide higher diagnostic accuracy for acute myocardial infarction (AMI) when compared with conventional assays, but may result in increased use of unnecessary coronary angiographies due to their increased detection of cardiomyocyte injury in conditions other than AMI.METHODS AND RESULTS: We evaluated the impact of the clinical introduction of high-sensitivity cardiac troponin T (hs-cTnT) on the use of coronary angiography, stress testing, and time to discharge in 2544 patients presenting with symptoms suggestive of AMI to the emergency department (ED) within a multicentre study either before (1455 patients) or after (1089 patients) hs-cTnT introduction. Acute myocardial infarction was more often the clinical discharge diagnosis after hs-cTnT introduction (10 vs. 14%, P < 0.001), while unstable angina less often the clinical discharge diagnosis (14 vs. 9%, P = 0.007). The rate of coronary angiography was similar before and after the introduction of hs-cTnT (23 vs. 23%, P = 0.092), as was the percentage of coronary angiographies showing no stenosis (11 vs. 7%, P = 0.361). In contrast, the use of stress testing was substantially reduced from 29 to 19% (P < 0.001). In outpatients, median time to discharge from the ED decreased by 79 min (P < 0.001). Mean total costs decreased by 20% in outpatients after the introduction of hs-cTnT (P = 0.002).CONCLUSION: The clinical introduction of hs-cTn does not lead to an increased or inappropriate use of coronary angiography. Introduction of hs-cTn is associated with an improved rule-out process and thereby reduces the need for stress testing and time to discharge.CLINICAL TRIAL REGISTRATION INFORMATION: www.clinicaltrials.gov. Identifier, NCT00470587.
AB - AIMS: High-sensitivity cardiac troponin (hs-cTn) assays provide higher diagnostic accuracy for acute myocardial infarction (AMI) when compared with conventional assays, but may result in increased use of unnecessary coronary angiographies due to their increased detection of cardiomyocyte injury in conditions other than AMI.METHODS AND RESULTS: We evaluated the impact of the clinical introduction of high-sensitivity cardiac troponin T (hs-cTnT) on the use of coronary angiography, stress testing, and time to discharge in 2544 patients presenting with symptoms suggestive of AMI to the emergency department (ED) within a multicentre study either before (1455 patients) or after (1089 patients) hs-cTnT introduction. Acute myocardial infarction was more often the clinical discharge diagnosis after hs-cTnT introduction (10 vs. 14%, P < 0.001), while unstable angina less often the clinical discharge diagnosis (14 vs. 9%, P = 0.007). The rate of coronary angiography was similar before and after the introduction of hs-cTnT (23 vs. 23%, P = 0.092), as was the percentage of coronary angiographies showing no stenosis (11 vs. 7%, P = 0.361). In contrast, the use of stress testing was substantially reduced from 29 to 19% (P < 0.001). In outpatients, median time to discharge from the ED decreased by 79 min (P < 0.001). Mean total costs decreased by 20% in outpatients after the introduction of hs-cTnT (P = 0.002).CONCLUSION: The clinical introduction of hs-cTn does not lead to an increased or inappropriate use of coronary angiography. Introduction of hs-cTn is associated with an improved rule-out process and thereby reduces the need for stress testing and time to discharge.CLINICAL TRIAL REGISTRATION INFORMATION: www.clinicaltrials.gov. Identifier, NCT00470587.
KW - Biomarkers
KW - Coronary Angiography
KW - Humans
KW - Myocardial Infarction
KW - Prospective Studies
KW - Troponin
U2 - 10.1093/eurheartj/ehw232
DO - 10.1093/eurheartj/ehw232
M3 - SCORING: Journal article
C2 - 27357358
VL - 37
SP - 3324
EP - 3332
JO - EUR HEART J
JF - EUR HEART J
SN - 0195-668X
IS - 44
ER -
