High-Sensitivity Troponin T Testing: Consequences on Daily Clinical Practice and Effects on Diagnosis of Myocardial
Christian Frédéric Zachoval1, Ramona Dolscheid-Pommerich2, Ingo Graeff3
1Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, 53127 Bonn, Germany.
Insights
The introduction of high-sensitivity troponin T (hs-TnT) testing in hospitals did not increase diagnostic procedures or interventions for acute myocardial infarction (AMI). However, hs-TnT testing was associated with a decrease in coded AMI diagnoses.
Area of Science:
- Clinical Chemistry
- Cardiology
- Health Services Research
Background:
- Conventional troponin I (cTnI) assays have limitations in diagnosing acute myocardial infarction (AMI).
- High-sensitivity troponin T (hs-TnT) assays offer improved sensitivity for detecting myocardial injury.
- The impact of hs-TnT adoption on AMI diagnosis and healthcare resource utilization remains unclear in unselected hospitalized populations.
Purpose of the Study:
- To evaluate the effect of introducing high-sensitivity troponin T (hs-TnT) testing versus conventional troponin I (cTnI) on acute myocardial infarction (AMI) diagnosis.
- To assess changes in resource utilization, including diagnostic tests and interventions, following hs-TnT implementation.
- To analyze the impact on the coded diagnosis of AMI in a general hospitalized patient cohort.
Main Methods:
- Retrospective analysis of 18,025 consecutive cases undergoing troponin testing.
- Comparison of two time frames: one using cTnI and the subsequent period using hs-TnT assays.
- Evaluation of troponin levels, diagnostic procedures (echocardiography, coronary angiography), interventions (percutaneous coronary intervention), and International Classification of Diseases (ICD)-10 coded AMI diagnoses.
Main Results:
- The incidence of troponin levels above the 99th percentile was significantly higher with hs-TnT assays.
- No significant increase was observed in the utilization of echocardiography, coronary angiography, or percutaneous coronary intervention.
- A significant decrease in the number of coded acute myocardial infarction (AMI) diagnoses was noted after the introduction of hs-TnT.
Conclusions:
- The implementation of hs-TnT assays in unselected hospitalized patients did not lead to increased downstream diagnostic testing or interventions for acute myocardial infarction (AMI).
- Despite higher detectable troponin levels, hs-TnT testing was associated with a reduction in the coded diagnosis of AMI.
- Further research is warranted to understand the clinical implications of these findings and potential shifts in diagnostic paradigms.
Abstract:
It remains unclear how introduction of high-sensitivity troponin T testing, as opposed to conventional troponin testing, has affected the diagnosis of acute myocardial infarction (AMI) and resource utilization in unselected hospitalized patients. In this retrospective analysis, we include all consecutive cases from our center during two corresponding time frames (10/2016-04/2017 and 10/2017-04/2018) for which different troponin tests were performed: conventional troponin I (cTnI) and high-sensitivity troponin T (hs-TnT) assays. Testing was performed in 18,025 cases. The incidence of troponin levels above the 99th percentile was significantly higher in cases tested using hs-TnT. This was not associated with increased utilization of echocardiography, coronary angiography, or percutaneous coronary intervention. Although there were no changes in local standard operating procedures, study site personnel, or national coding guidelines, the number of coded AMI significantly decreased after introduction of hs-TnT. In this single-center retrospective study comprising 18,025 mixed medical and surgical cases with troponin testing, the introduction of hs-TnT was not associated with changes in resource utilization among the general cohort, but instead, led to a decrease in the international classification of diseases (ICD)-10 coded diagnosis of AMI.
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