Outcomes in patients with chest pain in emergency departments using high-sensitivity versus conventional troponins
Maria Odqvist1,2, Nadia Bandstein3,4, Hans Tygesen1,2
1Department of Medicine, South Älvsborg Hospital, Borås, Sweden.
Insights
High-sensitivity troponin testing in emergency departments is associated with lower mortality for chest pain patients. This approach also increased the likelihood of coronary angiography and revascularization, suggesting a survival benefit.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Diagnostics
Background:
- Limited data exists on the comparative effectiveness of high-sensitivity troponin (hs-cTn) versus conventional troponin (cTn) in emergency department (ED) chest pain patients.
- Troponin assays are crucial for diagnosing acute myocardial infarction, but differences in sensitivity may impact patient outcomes.
Purpose of the Study:
- To investigate the association between high-sensitivity troponin T (hs-cTnT) testing and patient outcomes compared to conventional troponin (cTn).
- To evaluate the impact of hs-cTnT on 1-year mortality, missed acute coronary syndromes (ACSs), coronary angiography use, and revascularization rates in chest pain patients presenting to EDs.
Main Methods:
- An observational cohort study included 170,461 chest pain patients from 14 Swedish hospitals (2011-2016).
- Data on patient characteristics and outcomes were collected from nationwide registries.
- Cox regression analysis was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for key outcomes.
Main Results:
- Patients tested with hs-cTnT (n=107,792) had significantly lower 1-year all-cause mortality (3.7%) compared to those tested with cTn (n=62,669; 4.6%).
- The hs-cTnT group showed a 9% reduction in mortality (HR 0.91, 95% CI 0.87-0.94).
- Patients in the hs-cTnT group were more likely to undergo coronary angiography (14% increase) and revascularization (12% increase) within 30 days.
Conclusions:
- Emergency department utilization of hs-cTnT in chest pain patients is linked to reduced mortality.
- hs-cTnT testing is associated with increased rates of diagnostic coronary angiography and therapeutic revascularization.
- These findings suggest a potential survival benefit for chest pain patients managed with hs-cTnT assays compared to cTn.
Abstract:
Objectives. There is a paucity of data regarding the association between the use of high-sensitivity troponin (hs-cTn) compared with conventional troponin (cTn) and outcomes in chest pain patients in emergency departments (EDs). This study examined the impact of hs-cTnT on prognosis in chest pain patients in EDs. Design. In an observational cohort study, we included chest pain patients visiting the EDs of 14 hospitals in Sweden from 2011 to 2016. The study population was retrieved from each hospital, and information on characteristics and outcomes was collected from nationwide registries. Cox regression was used to estimate adjusted hazard ratios with 95% confidence intervals (HR, 95% CI) for (1) 1-year all-cause mortality, (2) missed acute coronary syndromes (ACSs), (3) use of coronary angiography, and (4) revascularizations within 30 days. Results. We included 170461 patients with chest pain where 62669 patients were tested with cTn while 107792 patients were tested with hs-cTnT. We found 4149 (4.6%) deaths in the cTn group and 6087 (3.7%) deaths in the hs-cTnT group. Patients in the hs-cTnT group had 9% lower mortality (0.91, 0.87-0.94), and were 14% more likely to undergo coronary angiography (1.14, 1.10-1.17), and 12% more likely to be revascularized (1.12, 1.08-1.17) than patients in the cTn group. Conclusions. Patients with chest pain visiting EDs using hs-cTnT had lower mortality and a higher likelihood of undergoing coronary angiographies and revascularizations than those using cTn. There may be a survival benefit of being tested with hs-cTnT compared with cTn in patients seeking medical attention for chest pain.
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