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Consequences of implementing a cardiac troponin assay with improved sensitivity at Swedish coronary care units: an analysis from the SWEDEHEART registry
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
Karolinska Univ Hosp, Karolinska Inst, Cardiol Sect, Dept Med, Stockholm, Sweden..
Karolinska Univ Hosp, Karolinska Inst, Cardiol Sect, Dept Med, Stockholm, Sweden..
2016 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, no 30, 2417-2424 p.Article in journal (Refereed) Published
Abstract [en]

Aims: Cardiac troponin (cTn) assays with improved sensitivity are increasingly utilized for the assessment of patients admitted because of suspected acute coronary syndrome (ACS). However, data on the clinical consequences of the implementation of such assays are limited.

Methods and results: In a retrospective register-based study (37 710 coronary care unit admissions; SWEDEHEART registry), we compared the case mix, the use of diagnostic procedures, treatments, and 1-year all-cause mortality 1 year before the implementation of a cTn assay with improved sensitivity (study period 1) and 1 year thereafter (study period 2). During study period 2, more at-risk patients were admitted and more patients had cTn levels above the myocardial infarction cut-off (ACS patients + 13.1%; non-ACS patients + 160.1%). cTn levels above this cut-off exhibited stronger associations with mortality risk in study period 2 (adjusted HR 4.45 [95% confidence interval, CI, 3.36-5.89]) compared with period 1 (adjusted HR 2.43 [95% CI 2.11-2.80]), similar as for the cTn ratio relative to the respective 99th percentile. While therewas no multivariable-adjusted increase in the use of diagnostic procedures, significant trends towards more differentiated treatment depending on the cause of cTn elevation, i. e. ACS or non-ACS, were noted.

Conclusions: The implementation of a cTn assay with improved sensitivity was associated with an increase in the number of patients who due to their cTn-status were identified as suitable for beneficial therapies. There was no inappropriate increase in hospital resource utilization. As such, cTn assays with improved sensitivity provide an opportunity to improve the clinical management of patients with suspected ACS.

Place, publisher, year, edition, pages
2016. Vol. 37, no 30, 2417-2424 p.
Keyword [en]
Cardiac troponin, Acute coronary syndrome, Clinical management, Cardiovascular outcomes, Coronary care unit
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-305572DOI: 10.1093/eurheartj/ehw029ISI: 000383599100012PubMedID: 26916797OAI: oai:DiVA.org:uu-305572DiVA: diva2:1038569
Funder
Swedish Foundation for Strategic Research
Available from: 2016-10-19 Created: 2016-10-19 Last updated: 2016-10-19Bibliographically approved

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Eggers, Kai M.Lindahl, Bertil
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