Impact of the Introduction of High-Sensitive Troponin Assay in the Emergency Department: A Retrospective Study.
Acute Coronary Syndrome
/ blood
Adult
Aged
Angina, Unstable
/ blood
Blood Chemical Analysis
/ methods
Chest Pain
/ blood
Coronary Angiography
/ statistics & numerical data
Echocardiography
/ statistics & numerical data
Emergency Service, Hospital
Exercise Test
/ statistics & numerical data
Female
Humans
Male
Middle Aged
Myocardial Perfusion Imaging
/ statistics & numerical data
Non-ST Elevated Myocardial Infarction
/ blood
Retrospective Studies
Switzerland
Tomography, X-Ray Computed
/ statistics & numerical data
Troponin T
/ blood
Ultrasonography
/ statistics & numerical data
Acute coronary syndrome
Chest pain
High-sensitive troponin test
Noncardiac chest pain
Overdiagnosis
Troponin test
Journal
The American journal of medicine
ISSN: 1555-7162
Titre abrégé: Am J Med
Pays: United States
ID NLM: 0267200
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
19
11
2019
revised:
21
12
2019
accepted:
24
12
2019
pubmed:
29
1
2020
medline:
22
9
2020
entrez:
29
1
2020
Statut:
ppublish
Résumé
Compared with troponin T/I test, the introduction of a high-sensitive (hs) troponin test may result in a higher proportion of positive test results in patients with chest pain and over-testing in patients without acute coronary syndrome. We assessed the impact of the introduction of the hs-troponin assay on the discharge diagnoses and the number of diagnostic tests in patients presenting with chest pain in a real-life setting in an emergency department. Retrospective chart review of patients presenting with chest pain to one of the largest hospitals in Switzerland. We compared the standard troponin period (December 2009 to November 2010) with the hs-troponin period (December 2010 to December 2011). Data from 1274 patients (standard 597 [46.9%], hs-troponin 677 [53.1%]) were analyzed. The proportion of patients with non-ST-segment elevation myocardial infarction increased (hs-troponin 14.9%, compared with 9.7%); the proportion in unstable angina (1.5% to 4.0%) and other cardiac illnesses (8.1% to 11.7%) decreased. Although the proportion of noncardiac chest pain illnesses (67%) remained unchanged, the proportion of positive hs-troponin was higher (6.1% vs 2.0%). The average number of additional tests/person decreased in troponin-positive patients (2.0 to 1.7 test per patient; P = .02) and troponin-negative patients (3.1 to 2.8 tests; P < .0001). Although the introduction of the hs-troponin test resulted in a higher proportion of positive hs-troponin tests in patients with noncardiac chest pain, the average number of diagnostic tests decreased in patients with chest pain presenting to an emergency department, indicating an increased confidence of clinicians in their diagnosis.
Sections du résumé
BACKGROUND
Compared with troponin T/I test, the introduction of a high-sensitive (hs) troponin test may result in a higher proportion of positive test results in patients with chest pain and over-testing in patients without acute coronary syndrome. We assessed the impact of the introduction of the hs-troponin assay on the discharge diagnoses and the number of diagnostic tests in patients presenting with chest pain in a real-life setting in an emergency department.
METHODS
Retrospective chart review of patients presenting with chest pain to one of the largest hospitals in Switzerland. We compared the standard troponin period (December 2009 to November 2010) with the hs-troponin period (December 2010 to December 2011).
RESULTS
Data from 1274 patients (standard 597 [46.9%], hs-troponin 677 [53.1%]) were analyzed. The proportion of patients with non-ST-segment elevation myocardial infarction increased (hs-troponin 14.9%, compared with 9.7%); the proportion in unstable angina (1.5% to 4.0%) and other cardiac illnesses (8.1% to 11.7%) decreased. Although the proportion of noncardiac chest pain illnesses (67%) remained unchanged, the proportion of positive hs-troponin was higher (6.1% vs 2.0%). The average number of additional tests/person decreased in troponin-positive patients (2.0 to 1.7 test per patient; P = .02) and troponin-negative patients (3.1 to 2.8 tests; P < .0001).
CONCLUSION
Although the introduction of the hs-troponin test resulted in a higher proportion of positive hs-troponin tests in patients with noncardiac chest pain, the average number of diagnostic tests decreased in patients with chest pain presenting to an emergency department, indicating an increased confidence of clinicians in their diagnosis.
Identifiants
pubmed: 31987803
pii: S0002-9343(20)30040-1
doi: 10.1016/j.amjmed.2019.12.029
pii:
doi:
Substances chimiques
TNNT2 protein, human
0
Troponin T
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
976-985Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.