Lack of Change in the Incidence of Unstable Angina after Transition to High-Sensitivity Cardiac Troponin T
Olatunde Ola1, Jonathan D Knott2, Laura De Michieli3
1Department of Cardiovascular Diseases, Marshall University School of Medicine, Huntington, WV.
Insights
The implementation of high-sensitivity cardiac troponin T (hs-cTnT) did not alter unstable angina diagnoses or cardiac evaluations. However, hs-cTnT assays revealed more frequent troponin elevations, often linked to underlying heart conditions.
Area of Science:
- Cardiology
- Clinical Diagnostics
- Biomarker Analysis
Background:
- Unstable angina diagnosis relies on cardiac troponin (cTn) levels.
- Advancements in cTn assays, such as high-sensitivity cardiac troponin T (hs-cTnT), aim to improve diagnostic accuracy.
- Evaluating the clinical impact of transitioning to newer diagnostic assays is crucial.
Purpose of the Study:
- To assess the effect of implementing a 5th generation hs-cTnT assay on unstable angina incidence.
- To evaluate changes in cardiac diagnostic evaluations following hs-cTnT assay implementation.
- To analyze troponin T levels in relation to patient diagnoses and underlying conditions.
Main Methods:
- Retrospective cohort study of emergency department patients in the US.
- Comparison of troponin T measurements from 4th generation cTnT assay (pre-implementation) and 5th generation hs-cTnT assay (post-implementation).
- Analysis of diagnoses, cardiac evaluations (echocardiography, stress testing, angiography), and troponin levels.
Main Results:
- The incidence of unstable angina remained unchanged after the hs-cTnT assay transition (18 patients with 4th gen vs. 21 with 5th gen).
- A higher proportion of patients (33.3%) showed elevated troponin values with the hs-cTnT assay compared to the 4th generation assay (94.4% below 99th percentile).
- Elevated hs-cTnT levels were associated with underlying structural heart disease; no significant differences in cardiac evaluation frequency were observed.
Conclusions:
- Transitioning to the 5th generation hs-cTnT assay did not alter the diagnosed incidence of unstable angina.
- The hs-cTnT assay identified more frequent, stable troponin increases, often associated with structural heart disease.
- The frequency of cardiac diagnostic procedures remained consistent across both assay generations.
Objective:
This study evaluated the impact of high-sensitivity cardiac troponin T (hs-cTnT) implementation on the incidence and cardiac evaluations of patients with unstable angina.
Methods:
This was a retrospective U.S. cohort study of emergency department patients evaluated with cardiac troponin (cTn) measurements during the transition from 4th-generation cTnT (6 months pre-implementation) to 5th-generation hs-cTnT assay (6 months postimplementation).
Results:
Only 39 patients were diagnosed with unstable angina; 18 with 4th-generation cTnT and 21 with 5th-generation hs-cTnT. With 4th-generation cTnT assay, almost all (94.4%) had values < 99th upper reference limit, whereas 33.3% had at least one value > 99th (mean = 25ng/L and peak = 26 ng/L) with hs-cTnT assay. The latter had underlying structural heart disease. There were no significant differences in cardiac evaluations with echocardiography, stress testing, or invasive coronary angiography between the two groups.
Conclusions:
The incidence of unstable angina did not change with the transition to 5th-generation hs-cTnT assay. However, stable hs-cTnT increases were more common, likely due to underlying structural heart disease. There were no changes in the frequency of cardiac evaluations.
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