Frequency of Troponin Testing in Inpatient Versus Outpatient Settings

Farber, Adam; Suarez, Keith; Slicker, Kipp; Patel, Chhaya; Pope, Brandon; Kowal, Robert C.; Michel, Jeffrey B.

doi:10.1016/j.amjcard.2016.12.030

Cited by 16 publications

(11 citation statements)

References 10 publications

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“…However, the testing of large numbers of patients without AMI has contributed to poor positive predictive value (PPV) of those with type 1 AMI. 2 Data from our system have demonstrated a PPV < 30% in actual clinical practice with the majority of troponin values > 99th percentile not associated with type 1 AMI. 2,3 Troponin elevations are known to occur in conditions not associated with coronary plaque rupture including sepsis, pneumonia, stroke, atrial fibrillation, and congestive heart failure (CHF) 4 due to increased, yet unmet, myocardial oxygen demand resulting in a type 2 AMI.…”

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confidence: 76%

Inpatient Mortality and 30-Day Readmission Rates Associated with Troponin Testing in Patients without Acute Myocardial Infarction

et al. 2020

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confidence: 76%

Inpatient Mortality and 30-Day Readmission Rates Associated with Troponin Testing in Patients without Acute Myocardial Infarction

et al. 2020

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“…In unselected patients undergoing troponin testing, in ED prior to any hospitalisation, aggregating administrative data collections provide a unique source of information by virtue of their size . In an era of increasing accountability, and focusing on the equitable delivery of high‐quality care, such data sets can provide valuable information allowing characterisation of patient care and outcomes across institutions.…”

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confidence: 99%

Troponin measurements, myocardial infarction diagnoses and outcomes. An analysis of linked data from New South Wales, Australia

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Brieger

Juergens

et al. 2020

Internal Medicine Journal

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Background: Cardiac troponin assays are very widely requested tests, particularly in emergency departments. Thus, many seriously ill patients who may not have heart disease as their primary discharge diagnosis have undergone troponin testing during hospitalisation. Aims:To determine associations between cardiac troponin levels and mortality, including from cardiovascular and non-cardiovascular causes, among patients hospitalised in New South Wales, Australia over a 2-year period.Methods: Over a 2-year period (2006)(2007)(2008), 172 753 hospitalised patients had a quantitative or qualitative troponin assay performed in New South Wales (Australia). The associations were examined, using data linked to late outcomes, between elevations in levels of troponins T or I and 1-year mortality. Mortality was determined for International Statistical Classification of Diseases 10th Revision diagnostic groups.Results: Of 172 753 patients undergoing troponin testing, 44 357 (25%) had a cardiovascular diagnosis of whom (7% had myocardial infarction) 47 827 (28%) had a probable ischaemic heart disease diagnosis if the 23 873 (14%) of patients coded with 'chest pain' were included. In patients with a cardiovascular diagnosis and elevated troponin 3060 (1.8%) died in 12 months in comparison to 6262 (3.6%) in those with a non-cardiovascular disease diagnoses and elevated troponin. The 1-year mortality hazard with respect to a troponin elevation was 2.5 (95% confidence interval 2.3-2.7) and 2.0 (95% confidence interval 1.99-2.01) for those with a cardiovascular and non-cardiovascular diagnosis respectively. Conclusion:In a very large state-wide hospitalised patient cohort, among patients with elevated troponin levels and non-cardiac diagnoses, mortality was higher than in those with cardiovascular diagnoses, including MI.

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“…Data from our health care system indicate that 30% of hospitalized patients have troponin testing as part of their inpatient management. 9 Fewer than 3% of hospitalized patients are diagnosed with AMI, many with ST elevation allowing diagnosis by electrocardiographic criteria alone. More than 70% of elevated troponin values identified in our health care system are found in patients without AMI.…”

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confidence: 99%

“…When utilization was reviewed, most testing occurred in patients unlikely to have AMI or in whom the diagnosis would not be expected. 9 A pregnancy test is a good example of a test with high predictive value. A patient with a positive urine pregnancy test has a high likelihood of pregnancy.…”

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confidence: 99%