Impact of high-sensitivity cardiac troponin on use of coronary angiography, cardiac stress testing, and time to discharge in suspected acute myocardial infarction.

Twerenbold, Raphael; Jaeger, Cedric; Rubini Gimenez, Maria; Wildi, Karin; Reichlin, Tobias; Nestelberger, Thomas; Boeddinghaus, Jasper; Grimm, Karin; Puelacher, Christian; Moehring, Berit; Pretre, Gil; Schaerli, Nicolas; Campodarve, Isabel; Rentsch, Katharina; Steuer, Stephan; Osswald, Stefan; Mueller, Christian

Impact of high-sensitivity cardiac troponin on use of coronary angiography, cardiac stress testing, and time to discharge in suspected acute myocardial infarction.

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dc.contributor.author Twerenbold, Raphaelca
dc.contributor.author Jaeger, Cedricca
dc.contributor.author Rubini Gimenez, Mariaca
dc.contributor.author Wildi, Karinca
dc.contributor.author Reichlin, Tobiasca
dc.contributor.author Nestelberger, Thomasca
dc.contributor.author Boeddinghaus, Jasperca
dc.contributor.author Grimm, Karinca
dc.contributor.author Puelacher, Christianca
dc.contributor.author Moehring, Beritca
dc.contributor.author Pretre, Gilca
dc.contributor.author Schaerli, Nicolasca
dc.contributor.author Campodarve, Isabelca
dc.contributor.author Rentsch, Katharinaca
dc.contributor.author Steuer, Stephanca
dc.contributor.author Osswald, Stefanca
dc.contributor.author Mueller, Christianca
dc.date.accessioned 2017-03-06T08:42:14Z
dc.date.available 2017-03-06T08:42:14Z
dc.date.issued 2016
dc.description.abstract AIMS: High-sensitivity cardiac troponin (hs-cTn) assays provide higher diagnostic accuracy for acute myocardial infarction (AMI) when compared with conventional assays, but may result in increased use of unnecessary coronary angiographies due to their increased detection of cardiomyocyte injury in conditions other than AMI. METHODS AND RESULTS: We evaluated the impact of the clinical introduction of high-sensitivity cardiac troponin T (hs-cTnT) on the use of coronary angiography, stress testing, and time to discharge in 2544 patients presenting with symptoms suggestive of AMI to the emergency department (ED) within a multicentre study either before (1455 patients) or after (1089 patients) hs-cTnT introduction. Acute myocardial infarction was more often the clinical discharge diagnosis after hs-cTnT introduction (10 vs. 14%, P < 0.001), while unstable angina less often the clinical discharge diagnosis (14 vs. 9%, P = 0.007). The rate of coronary angiography was similar before and after the introduction of hs-cTnT (23 vs. 23%, P = 0.092), as was the percentage of coronary angiographies showing no stenosis (11 vs. 7%, P = 0.361). In contrast, the use of stress testing was substantially reduced from 29 to 19% (P < 0.001). In outpatients, median time to discharge from the ED decreased by 79 min (P < 0.001). Mean total costs decreased by 20% in outpatients after the introduction of hs-cTnT (P = 0.002). CONCLUSION: The clinical introduction of hs-cTn does not lead to an increased or inappropriate use of coronary angiography. Introduction of hs-cTn is associated with an improved rule-out process and thereby reduces the need for stress testing and time to discharge.ca
dc.description.sponsorship R.T. reports speaker honoraria from B.R.A.H.M.S. and Roche. T.R. reports grants from Swiss National Science Foundation (PASMP3-136995) as well as personal fees from Swiss Heart Foundation and from Goldschmidt-Jacobson Foundation. C.M. reports research grants from the Swiss National Science Foundation, the European Union, the KTI, and the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, 8sense, Abbott, ALERE, Astra Zeneca, Beckman Coulter, Biomerieux, Brahms, Critical Diagnostics,Nanosphere, Roche, Siemens, Singulex, and the University Hospital Basel, as well as speaker honoraria from Abbott, ALERE, Astra Zeneca, BG medicine, Biomerieux, BMS, Brahms, Cardiorentis, Daiichi Sankyo, Novartis, Radiometer, Roche, Sanofi, Siemens, and Singulex.
dc.format.mimetype application/pdfca
dc.identifier.citation Twerenbold R, Jaeger C, Rubini Gimenez M, Wildi K, Reichlin T, Nestelberger T. Impact of high-sensitivity cardiac troponin on use of coronary angiography, cardiac stress testing, and time to discharge in suspected acute myocardial infarction. Eur Heart J. 2016 Nov 21;37(44):3324-3332. doi: 10.1093/eurheartj/ehw232ca
dc.identifier.doi http://dx.doi.org/10.1093/eurheartj/ehw232
dc.identifier.issn 0195-668X
dc.identifier.uri http://hdl.handle.net/10230/28169
dc.language.iso engca
dc.publisher Oxford University Pressca
dc.relation.ispartof European Heart Journal. 2016 Nov 21;37(44):3324-32
dc.rights © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.comca
dc.rights.accessRights info:eu-repo/semantics/openAccessca
dc.rights.uri https://creativecommons.org/licenses/by-nc/4.0/ca
dc.subject.other Malalties coronàriesca
dc.subject.other Angiografiaca
dc.title Impact of high-sensitivity cardiac troponin on use of coronary angiography, cardiac stress testing, and time to discharge in suspected acute myocardial infarction.ca
dc.type info:eu-repo/semantics/articleca
dc.type.version info:eu-repo/semantics/publishedVersionca

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