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Rates of Echocardiography, Coronary Angiography, and Coronary Intervention Associated With Troponin Testing in
Gibbs Wilson1, Kevin Kurian1, Syed Zamin1
1Department of Medicine, Scott & White Heart Memorial Hospital, Temple, Texas.
Insights
Elevated cardiac troponin levels, even without acute myocardial infarction (AMI), correlate with increased use of echocardiography (ECHO), coronary angiography (CAG), and percutaneous coronary intervention (PCI). This association was observed across various primary diagnoses, highlighting troponin
Area of Science:
- Cardiology
- Clinical Diagnostics
- Biomarker Research
Background:
- Cardiac troponin elevation is a key biomarker for acute myocardial infarction (AMI).
- Elevated troponin levels are also observed in patients without AMI, necessitating further investigation into their clinical significance.
- Previous research indicated a link between troponin elevation and diagnostic procedures in sepsis patients.
Purpose of the Study:
- To investigate the association between elevated troponin levels and the utilization of echocardiography (ECHO), coronary angiography (CAG), and percutaneous coronary intervention (PCI).
- To determine if this association extends to primary diagnoses beyond sepsis.
- To explore the correlation between troponin I values and the use of these cardiac interventions.
Main Methods:
- Retrospective review of inpatient admissions from nine Texas hospitals in 2016.
- Data collected included International Statistical Classification of Diseases and Related Health Problems (ICD-10) diagnoses, troponin test results, and records of ECHO, CAG, or PCI.
- Patients were categorized by primary diagnosis: AMI, non-AMI, congestive heart failure (CHF), sepsis, and others.
Main Results:
- Out of 56,895 admissions, 14,326 (25.2%) underwent troponin testing, with 26.1% showing troponin I values ≥0.1 ng/mL.
- Troponin testing was associated with increased ECHO, CAG, and PCI use in all diagnostic groups except CHF.
- Troponin I levels ≥0.1 ng/mL were significantly linked to higher rates of ECHO, CAG, and PCI across all patient groups.
Conclusions:
- Elevated troponin levels, irrespective of an AMI diagnosis, are associated with increased utilization of cardiac diagnostic and interventional procedures.
- The findings suggest that troponin elevation serves as a clinical indicator prompting further cardiac evaluation and intervention in a broader patient population.
- Healthcare providers should consider the implications of troponin elevation beyond AMI diagnosis when managing inpatient care.
Abstract:
Diagnosis of acute myocardial infarction (AMI) often depends on detection of cardiac troponin elevation >99th percentile. However, troponin elevation is commonly found in patients without AMI. We have previously reported an association between troponin elevation and rates of electrocardiogram (ECG), echocardiography (ECHO), and coronary angiography (CAG) in patients with a primary diagnosis of sepsis. We hypothesized that elevated troponin might be associated with greater use of ECHO and CAG in primary diagnoses other than sepsis and that this correlation might also include percutaneous coronary intervention (PCI). We reviewed all inpatient admissions to nine hospitals in Texas in 2016 collecting primary International Statistical Classification of Diseases and Related Health Problems (International Classification of Diseases-10) diagnoses, troponin test data, and the presence of ECHO, CAG, or PCI during hospitalization. We identified 56,895 unique inpatient admissions, of which 14,326 (25.2%) were associated with troponin testing. Of patients tested, 26.1% had one or more troponin I values ≥0.1 ng/ml (99th percentile). Primary ICD-10 diagnoses were grouped into (1) AMI, (2) primary diagnosis other than AMI (non-AMI), (3) congestive heart failure (CHF), (4) sepsis, and (5) Other excluding AMI, CHF, or sepsis. Troponin testing was itself associated with greater utilization of ECHO, CAG, and PCI in all groups except CHF. Troponin I values ≥0.1 ng/ml were associated with increased rates of ECHO, CAG, and PCI across all groups.
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