Resource utilization and outcome among patients with selective versus nonselective troponin testing

Area of Science:

• Cardiology
• Clinical Diagnostics
• Health Services Research

Background:

• Troponin testing is crucial for diagnosing acute coronary syndrome (ACS).
• Testing has expanded beyond suspected ACS, raising concerns about resource use and outcomes.
• The consequences of nonselective troponin testing remain unclear.

Purpose of the Study:

• To compare selective (ACS) versus nonselective (non-ACS) troponin testing.
• To analyze patient characteristics, resource utilization, and outcomes.
• To evaluate the impact of troponin testing in a broader patient population.

Main Methods:

• Retrospective analysis of troponin testing in a U.S. emergency department over one year.
• Classification of testing as selective (ACS) or nonselective (non-ACS) using ICD-9 codes.
• Analysis of troponin levels relative to the 99th percentile upper reference limit (URL).

Main Results:

• Non-ACS patients (77%) were older, had longer hospital stays, and higher 1-year mortality (22% vs. 6.7%) than ACS patients.
• Troponin elevation (≥URL) predicted 1-year mortality in both groups, more pronounced in non-ACS (35% vs. 13%).
• Revascularization rates differed significantly between ACS and non-ACS groups with elevated troponin (48% vs. 4.7%).

Conclusions:

• Contemporary troponin testing is predominantly nonselective.
• Significant differences exist in clinical profiles, treatment, and outcomes between ACS and non-ACS populations.
• Elevated troponin is a potent predictor of mortality in non-ACS patients, highlighting potential for risk stratification and intervention.