Long-Term Major Adverse Cardiovascular Events in Patients "Appropriately" Tested for Troponin Assays in Emergency...

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Diagnostics

Background:

• Troponin testing is vital for diagnosing myocardial ischemia in acute coronary syndrome (ACS) in the emergency department (ED).
• However, overuse of troponin tests leads to false positives, patient anxiety, and unnecessary interventions.

Purpose of the Study:

• To establish appropriateness criteria for troponin testing in the ED.
• To evaluate the long-term major adverse cardiac events (MACE) associated with troponin testing.

Main Methods:

• Retrospective analysis of 407 patients undergoing troponin testing at a tertiary-care hospital.
• Categorization of troponin tests as appropriate or inappropriate based on established criteria.
• Long-term follow-up (over 540 days) to track MACE.

Main Results:

• 62% of troponin tests were deemed appropriate; 38% were inappropriate.
• Higher MACE rates were observed in the appropriate testing group (21%) compared to the inappropriate group (10%).
• Appropriate testing was associated with an increased adjusted risk of MACE (HR 2.55).

Conclusions:

• Judicious troponin testing is supported by these findings.
• Robust appropriateness criteria are necessary to prevent overdiagnosis and inappropriate testing in the ED.
• Optimizing troponin test ordering can improve patient outcomes and resource utilization.