Clinical impact of using a more sensitive troponin assay in patients with acute chest pain.

Abstract

BackgroundMore sensitive troponin assays have the potential to better evaluate patients with suspected acute coronary syndrome (ACS). Meanwhile, they may result in avoidable diagnostic testing.HypothesisOur aim was to determine the clinical impact of implementing a more sensitive cardiac troponin I (cTnI) assay in patients with acute non‐traumatic chest pain presenting to the emergency department (ED).MethodsThis is a pre‐post cohort study. A total of 1201 consecutive patients with acute non‐traumatic chest pain or equivalent ischemic symptoms suggestive of ACS were allocated to two groups according to the cTnI assay used. The outcomes included the ED length of stay (LOS), hospital admission rate, the use of procedures and the incidence of major adverse cardiac events (MACE) at 30 days.ResultsThe introduction of the more sensitive troponin assay shortened ED LOS (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.28‐0.54) regarding patients discharged home directly, increased the hospital admission rate (OR 1.43, 95% CI 1.12‐1.84), the use of echocardiography (OR 1.58, 95% CI 1.22‐2.06), coronary computed tomography angiography (OR 1.78, 95% CI 1.04‐3.06), coronary angiography (OR 1.53, 95% CI 1.10‐2.12) and percutaneous coronary intervention (OR 2.42, 95% CI 1.58‐3.70) regarding patients discharged or admitted. The incidence of MACE did not decrease significantly (OR 0.61, 95% CI 0.27‐1.37).ConclusionsThe introduction of the more sensitive troponin assay appeared to result in less time spent in the ED regarding patients discharged home directly, but prompted more hospitalizations and procedures without impacting the incidence of MACE.