Randomized comparison of high-sensitivity troponin reporting in undifferentiated chest pain assessment

Derek P. Chew, Christopher Zeitz, Matthew Worthley, Hugh Grantham, John Beltrame, Margaret Arstall, Penelope Coates, Carolyn Astley, Stephen Quinn, Julie Ratcliffe, Matthew Horsfall, Philip G. Aylward

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13 Citations (Scopus)

Abstract

Background - High-sensitivity troponin T (hs-TnT) assays promise greater discrimination of evolving myocardial infarction, but the impact of unguided implementation on the effectiveness of care is uncertain. Methods and Results - We evaluated the impact of hs-TnT reporting on care and outcome among chest pain patients presenting to 5 emergency departments within a multicenter randomized trial. Patients were allocated to hs-TnT reporting (hs-report) or standard reporting (std-report; Roche Elecys). The primary end point was death and new or recurrent acute coronary syndrome by 12 months. A total of 1937 patients without ST-segment elevation were enrolled between July 2011 and March 2013. The median age was 61 (interquartile range, 48-74) years, and 46.3% were women. During the index hospitalization, 1466 patients (75.7%) had maximal troponin <30 ng/L within 24 hours. Randomization to hs-report format did not alter the admission rate (hs-report: 57.7% versus std-report: 58.0%; P=0.069). There was no difference in angiography (hs-report: 11.9% versus std-report: 10.9%; P=0.479). The hs-reporting did not reduce 12-month death or new/recurrent acute coronary syndrome in the overall population (hs-report: 9.7% versus std-report: 7.2% [hazard ratio, 0.83 (0.57-1.22); P=0.362]). However, among those with troponin levels <30 ng/L, a modest reduction in the primary end point was observed (hs-report: 2.6% versus std-report: 4.4%, [hazard ratio, 0.58; 95% confidence interval, 0.34-0.1.00; P=0.050). Conclusions - High-sensitivity troponin reporting alone is associated with only modest changes in practice. Clinical effectiveness in the adoption of high-sensitivity troponin may require close coupling with protocols that guide interpretation and care.

Original languageEnglish
Pages (from-to)542-553
Number of pages12
JournalCirculation: Cardiovascular Quality and Outcomes
Volume9
Issue number5
DOIs
Publication statusPublished - 1 Sep 2016

Keywords

  • acute coronary syndrome
  • angiography
  • clinical trial
  • myocardial infarction
  • troponin T

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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