Abstract
It remains unclear how introduction of high-sensitivity troponin T testing, as opposed to conventional troponin testing, has affected the diagnosis of acute myocardial infarction (AMI) and resource utilization in unselected hospitalized patients. In this retrospective analysis, we include all consecutive cases from our center during two corresponding time frames (10/2016–04/2017 and 10/2017–04/2018) for which different troponin tests were performed: conventional troponin I (cTnI) and high-sensitivity troponin T (hs-TnT) assays. Testing was performed in 18,025 cases. The incidence of troponin levels above the 99th percentile was significantly higher in cases tested using hs-TnT. This was not associated with increased utilization of echocardiography, coronary angiography, or percutaneous coronary intervention. Although there were no changes in local standard operating procedures, study site personnel, or national coding guidelines, the number of coded AMI significantly decreased after introduction of hs-TnT. In this single-center retrospective study comprising 18,025 mixed medical and surgical cases with troponin testing, the introduction of hs-TnT was not associated with changes in resource utilization among the general cohort, but instead, led to a decrease in the international classification of diseases (ICD)-10 coded diagnosis of AMI.
Highlights
Since their implementation into clinical practice, conventional troponin I assays have enabled physicians to diagnose myocardial infarction more accurately than any other biomarker assay
Reliable data and algorithms on high-sensitivity troponin testing and decision making in the emergency care setting, with regard to chest-pain patients or non-ST-elevation ACS, have been published [7,8,24], but no large study has investigated the consequences of using high-sensitivity troponin T on the diagnosis of myocardial infarction and resource utilization in an undifferentiated cohort of non-emergency department (ED), non-chest-pain, mixed surgical and medical patients
We analyzed different subgroups: patients hospitalized in the cardiology department (Subgroup 1), patients hospitalized in other departments (Subgroup 2), and lastly, to investigate the findings in a cohort of patients with high a priori probability for the diagnosis of acute myocardial infarction (Subgroup 3), we applied clinically relevant laboratory criteria to all inpatients of the cardiology department in a separate analysis: with high-sensitivity troponin testing based on the ESC high-sensitivity troponin T (hs-TnT) 0/1h algorithm [7,8,24,25] and regarding patients with conventional troponin testing with markedly elevated conventional troponin I (cTnI) values (i.e., 5 times the normal upper limit) or a 50% dynamic change between two serial measurements
Summary
Since their implementation into clinical practice, conventional troponin I (cTnI) assays have enabled physicians to diagnose myocardial infarction more accurately than any other biomarker assay. They have significantly facilitated treatment selection and patient-risk stratification and have become cornerstones of routine clinical practice [1,2,3,4,5]. Reliable data and algorithms on high-sensitivity troponin testing and decision making in the emergency care setting, with regard to chest-pain patients or non-ST-elevation ACS, have been published [7,8,24], but no large study has investigated the consequences of using high-sensitivity troponin T (hs-TnT) on the diagnosis of myocardial infarction and resource utilization in an undifferentiated cohort of non-emergency department (ED), non-chest-pain, mixed surgical and medical patients. The present study aimed to test the hypothesis, that introduction of high-sensitivity troponin testing would result in an increase of resource utilization and diagnosis of acute myocardial infarction in an unselected patient population
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