Is there excessive troponin testing in clinical practice? Evidence from emergency medical admissions

Conway, Richard; Byrne, Declan; Cournane, Seán; O’Riordan, Deirdre; Coveney, Seamus; Silke, Bernard

doi:10.1016/j.ejim.2020.12.009

Cited by 6 publications

(2 citation statements)

References 32 publications

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“…For their tissue specificity, cTnT and cTnI assay are the principal blood tests for diagnosing acute coronary syndrome (ACS) or other acute cardiac damage. For this reason, they are frequently used in screening blood tests in emergency room admission ( Conway et al., 2021 ). With the advent of the high sensitivity (Hs) assay, the specific role of cTn in acute myocardial injury diagnosis is decreased.…”

Section: Introductionmentioning

confidence: 99%

Admission high-sensitivity cardiac troponin levels as a prognostic indicator for in-hospital mortality rates in the elderly and very elderly COVID-19 patients

Menditto

Protic

Rosa

et al. 2023

Archives of Gerontology and Geriatrics

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Section: Introductionmentioning

confidence: 99%

Admission high-sensitivity cardiac troponin levels as a prognostic indicator for in-hospital mortality rates in the elderly and very elderly COVID-19 patients

Menditto

Protic

Rosa

et al. 2023

Archives of Gerontology and Geriatrics

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“…Owing to their tissue specificity, cTnT and cTnI assays are the principal blood tests used to diagnose ACS or other conditions when myocyte damage is suspected. Hence, they are commonly used in screening blood tests in the healthcare setting [11].…”

Section: Introductionmentioning

confidence: 99%

Elevated Troponins and Diagnosis of Non-ST-Elevation Myocardial Infarction in the Emergency Department

Ali,

Arshad,

Szpunar

et al. 2024

Cureus

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BackgroundIn the emergency department (ED), the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) is primarily based on the presence or absence of elevated cardiac troponin levels, ECG changes, and clinical presentation. However, limited data exist regarding the incidence, clinical characteristics, and predictive value of different cardiac diagnostic tests and outcomes in patients with non-acute coronary syndrome (ACS)-related troponin elevation. Our study aimed to determine the percentage of patients with elevated troponin levels who had true ACS and identify various risk factors associated with true ACS in these patients. MethodologyThis was a single-center retrospective study. We performed a chart review of patients who presented to the ED from January 1, 2016, to December 31, 2017, and were admitted to the hospital with an elevated cardiac troponin I level in the first 12 hours after ED presentation with a diagnosis of NSTEMI. True ACS was defined as (a) patients with typical symptoms of ischemia and ECG ischemic changes and (b) patients with atypical symptoms of myocardial ischemia or without symptoms of ischemia and new segmental wall motion abnormalities on echocardiogram or evidence of culprit lesion on angiography. A logistic regression model was used to determine the association between risk factors and true ACS. ResultsA total of 204 patients were included in this study. The mean age of the study group was 67.4 ± 14.5 years; 53.4% (n = 109) were male, and 57.4% (n = 117) were Caucasian. In our study, 51% of patients were found to have true ACS, and the remaining 49% had a non-ACS-related elevation in troponins. Most patients without ACS had alternate explanations for elevated troponin levels. The presence of chest pain (odds ratio (OR) = 3.7, 95% confidence interval (CI) = 1.8-7.7, p = 0.001), tobacco smoking (OR = 4, 95% CI = 1.06-3.8, p = 0.032), and wall motion abnormalities on echocardiogram (OR = 3.8, 95% CI = 1.8-6.5, p = 001) were associated with increased risk of true ACS in patients with elevated troponins. ConclusionsCardiac troponin levels can be elevated in hospitalized patients with various medical conditions, in the absence of ACS. The diagnosis of ACS should not be solely based on elevated troponin levels, as it can lead to expensive workup and utilization of hospital resources.

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Improved Utilization of Serial Testing Without Increased Admissions after Implementation of High-Sensitivity Troponin I: a Controlled Retrospective Cohort Study

Warren,

Fischer,

Shemesh

et al. 2023

J GEN INTERN MED

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Is there excessive troponin testing in clinical practice? Evidence from emergency medical admissions

Cited by 6 publications

References 32 publications

Admission high-sensitivity cardiac troponin levels as a prognostic indicator for in-hospital mortality rates in the elderly and very elderly COVID-19 patients

Admission high-sensitivity cardiac troponin levels as a prognostic indicator for in-hospital mortality rates in the elderly and very elderly COVID-19 patients

Elevated Troponins and Diagnosis of Non-ST-Elevation Myocardial Infarction in the Emergency Department

Improved Utilization of Serial Testing Without Increased Admissions after Implementation of High-Sensitivity Troponin I: a Controlled Retrospective Cohort Study

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