Decreased admissions and hospital costs with a neutral effect on mortality following lowering of the troponin T cutoff point to the 99th percentile

Abstract

Background: The implementation of high-sensitivity cardiac troponin T (hs-cTnT) assays and a cutoff based on the 99th cTnT percentile in the evaluation of patients with suspected acute coronary syndrome has not been uniform due to uncertain effects on health benefits and utilization of limited resources. (5.3% vs. 7.6%, p < 0.001). The MI frequency was unchanged (4.0% vs. 3.9%, p = 0.72) (Cardiol J 2017; 24, 6: 612-622) Methods: Clinical and laboratory data from patients with chest pain or dyspnea at the emergency department (ED) were evaluated before (n = 20516) and after (n = 18485) the lowering of the hs-cTnT cutoff point from 40 ng/L to the 99th hs-cTnT percentile of 14 ng/L in February 2012. Myocardial infarction (MI) was diagnosed at the discretion of the attending clinicians responsible for the patient. Results: Following lowering of the hs-cTnT cutoff point fewer ED patients with chest pain or dyspnea as the principal complaint were analyzed with an hs-cTnT sample (81% vs. 72%, p < 0.001). Overall 30-day mortality was unaffected but increased among patients not analyzed with an hs-cTnT sample

Patients discharged with elevated baseline high-sensitive cardiac troponin T from the emergency department

“…Patients seeking healthcare at the EDs at Sahlgrenska University Hospital (SU/Sahlgrenska) with a chief complaint of chest pain or dyspnoea and with at least one hs-cTnT sample ordered from the ED between 1 February 2012 and 30 September 2015 were included in the study. The collection of data was similar to a previous study from our hospital (Bjurman et al 2017). Cohort 2 specified in Bjurman et al (2017) is an overlapping dataset from the same hospital where the hs-cTnT sampling frequency and examinations are given.…”

“…The collection of data was similar to a previous study from our hospital (Bjurman et al 2017). Cohort 2 specified in Bjurman et al (2017) is an overlapping dataset from the same hospital where the hs-cTnT sampling frequency and examinations are given. Additional data on examinations and lab tests, not part of this publication, are listed in Supplemental Table 1.…”

“…Risk scores (Chapman et al 2018) and coronary CT and triple rule as recommended by ESC latest guidelines (Collet et al 2021) were not in place at the time of the study. Patients with NSTEMI were diagnosed at the discretion of the attending clinician by reviewing available clinical and laboratory data collected during the hospital stay as described in Supplementary material in Bjurman et al (2017).…”

“…Cardiac-specific troponins (cTn) are biomarkers that are primarily used when acute myocardial infarction (MI) is suspected (Thygesen et al 2012). Several reports indicate that high-sensitive cTn (hs-cTn) assays and diagnostic cut-off points based on the 99th troponin percentile value in healthy patients improve diagnostic accuracy (Bandstein et al 2014, Reichlin et al 2015 and reduce hospital spending (Bjurman et al 2017). However, the increased ability to exclude MI has been accompanied by an accumulation of patients presenting with hs-cTn levels above the accepted cut-off point without MI (Hammarsten et al 2012, Hammarsten et al 2017 for which no consensus treatment exist.…”

Cardiac troponin I and T: Exploring popularity with Google Trends

“…There is now firm evidence that the measurement of cardiac troponins, either I (cTnI) or T (cTnT) using high-sensitivity immunoassays, is the mainstay for diagnosing both ischemic and non--ischemic myocardial injury, regardless of the cutoff point, as we have read in the article by Bjurman et al [1]. Recent evidence attests that neither of these two biomarkers seem superior to the other for the purposes of diagnosing myocardial infarction, so that they can be ideally used interchangeably [2].…”