The outcome of patients with troponin T with and without an acute coronary syndrome

Abstract

Background: Troponin T (TnT) measurement is important for diagnostic triage in acute coronary syndrome (ACS). The outcome of patients with a TnT request who do not have ACS has rarely been reported. Aims and methods: To report the relationship between clinical ACS, TnT testing and the proportion with and without ACS who have an TnT request. The Hull and East Yorkshire Hospitals serve a population of approximately 560,000. All TnT tests are done in a single laboratory. Patients admitted with ACS were identified prospectively by trained nurses from 1st January to 31st December 2005. Patients with a death or discharge code of MI were also identified by the hospital information department and from the Myocardial Infarction National Audit Project (MINAP) records. Values of TnT >0.03ug/L were considered positive. High-sensitivity TnT was not introduced until after December 2010. WHO criteria for anaemia were used (male<13 g/dL; female<12 g/dL). Results: Of 5522 patients who were tested,1679 had a raised TnT and of these 856 were and 823 were not reported to have ACS. Of 3843 patients with TnT <0.03ug/L, 669 were and 3174 were not reported to have ACS. View this table: Table 1 Conclusion: Amongst patients with ACS, those with a negative TnT have a much better prognosis than those with a positive test. However, patients who have a raised TnT but are reported not to have ACS have an even worse outcome. This may partly reflect the age and underlying disease in this patient group but could also reflect sub-optimal management of cardiovascular risk. All patients with a raised TnT should be carefully assessed, especially when a diagnosis of ACS has been rejected.