Clinical Impact of High-Sensitivity Cardiac Troponin T Implementation in the Community

Olatunde Ola MD, MPH , Ashok Akula MD , Laura De Michieli MD , Marshall Dworak BS , Erika Crockford DO

Ronstan Lobo MB, BCh, BAO , Nicholas Rastas BS , Jonathan D. Knott MD , Ramila A. Mehta MS , David O. Hodge MS

Eric Grube DO , Swetha Karturi MD , Scott Wohlrab MBA , Tahir Tak MD , Charles Cagin DO , Rajiv Gulati MD,  PhD

Allan S. Jaffe MD  and Yader Sandoval MD

JACC (Journal of the American College of Cardiology), 2021-06-29, Volume 77, Issue 25, Pages 3160-3170, Copyright © 2021 American College of Cardiology Foundation

Abstract

Background

Limited U.S. data exist regarding high-sensitivity cardiac troponin (cTn) implementation.

Objectives

This study sought to evaluate the impact of high-sensitivity cardiac troponin T (cTnT) implementation.

Methods

Observational U.S. cohort study of emergency department (ED) patients undergoing measurement of cTnT during the transition from 4th (pre-implementation March 12, 2018, to September 11, 2018) to 5th generation (Gen) cTnT (post-implementation September 12, 2018, to March 11, 2019). Diagnoses were adjudicated following the Fourth Universal Definition of Myocardial Infarction (MI). Resources evaluated included length of stay, hospitalizations, and cardiac testing.

Results

In this study, 3,536 unique patients were evaluated, including 2,069 and 2,491 ED encounters pre- and post-implementation. Compared with 4th Gen cTnT, encounters with ≥1 cTnT >99th percentile increased using 5th Gen cTnT (15% vs. 47%; p < 0.0001). Acute MI (3.3% vs. 8.1%; p < 0.0001) and myocardial injury (11% vs. 38%; p < 0.0001) increased. Although type 1 MIs increased (1.7% vs. 2.9%; p = 0.0097), the overall MI increase was largely due to more type 2 MIs (1.6% vs. 5.2%; p < 0.0001). Women were less likely than men to have MI using 4th Gen cTnT (2.3% vs. 4.4%; p = 0.008) but not 5th Gen cTnT (7.7% vs. 8.5%; p = 0.46). Overall length of stay and stress testing were reduced, and angiography was increased (all p < 0.05). Among those without cTnT increases, there were more ED discharges and a reduction in length of stay, echocardiography, and stress tests (all p < 0.05).

Conclusions

High-sensitivity cTnT implementation resulted in a marked increase in myocardial injury and MI, particularly in women and patients with type 2 MI. Despite this, except for angiography, overall resource use did not increase. Among those without cTnT increases, there were more ED discharges and fewer cardiac tests.

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