Impact of the introduction of high-sensitive troponin assay in the emergency department: a retrospective study.

Burgstaller, Jakob M; Held, Ulrike; Gravestock, Isaac; Klauser, Benjamin S; Gort, Laura M; Melzer, Lina; Hasler, Susann; Bierreth, Tenzin D; Müller, Sarah E; Steurer, Johann; Wertli, Maria M. (2020). Impact of the introduction of high-sensitive troponin assay in the emergency department: a retrospective study. The American journal of medicine, 133(8), pp. 976-985. Elsevier 10.1016/j.amjmed.2019.12.029

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BACKGROUND

Compared to 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 ED.

METHODS

Retrospective chart review of patients presenting with chest pain to one of the largest hospitals in Switzerland. We compared the standard troponin period (12/2009 to 11/2010) to the hs-troponin period (12/2010 to 12/2011).

RESULTS

Data from 1,274 patients (standard 597 (46.9%), hs-troponin 677 (53.1%)) were analyzed. The proportion of patients with NSTEMI increased (hs-troponin 14.9% compared to 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 non-cardiac 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=0.02) and troponin negative patients (3.1 to 2.8 tests; p<0.0001).

CONCLUSION

Although the introduction of the hs-troponin test resulted in a higher proportion of positive hs-troponin tests in patients with non-cardiac chest pain, the average number of diagnostic tests decreased in patients with chest pain presenting to an ED indicating an increased confidence of clinicians in their diagnosis.

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