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Decreased admissions and hospital costs with a neutral effect on mortality following lowering of the troponin T cutoff point to the 99th percentile
Univ Gothenburg, Sahlgrenska Acad, Sahlgrenska Univ Hosp, Dept Med, Gothenburg, Sweden..
Univ Gothenburg, Sahlgrenska Acad, Sahlgrenska Univ Hosp, Dept Clin Chem & Transfus Med, Gothenburg, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.ORCID iD: 0000-0002-5795-0061
Univ Gothenburg, Sahlgrenska Acad, Sahlgrenska Univ Hosp, Dept Med, Gothenburg, Sweden..
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2017 (English)In: Cardiology journal, ISSN 1897-5593, Vol. 24, no 6, p. 612-622Article in journal (Refereed) Published
Abstract [en]

Background:

The implementation of high-sensitivity cardiac troponin T (hs-cTnT) assays and a cutoff based on the 99th cTnT percentile in the evaluation of patients with suspected acute coronary syndrome has not been uniform due to uncertain effects on health benefits and utilization of limited resources.

Methods:

Clinical and laboratory data from patients with chest pain or dyspnea at the emergency department (ED) were evaluated before (n = 20516) and after (n = 18485) the lowering of the hs-cTnT cutoff point from 40 ng/L to the 99th hs-cTnT percentile of 14 ng/L in February 2012. Myocardial infarction (MI) was diagnosed at the discretion of the attending clinicians responsible for the patient.

Results:

Following lowering of the hs-cTnT cutoff point fewer ED patients with chest pain or dyspnea as the principal complaint were analyzed with an hs-cTnT sample (81% vs. 72%, p < 0.001). Overall 30-day mortality was unaffected but increased among patients not analyzed with an hs-cTnT sample (5.3% vs. 7.6%, p < 0.001). The MI frequency was unchanged (4.0% vs. 3.9%, p = 0.72) whereas admission rates decreased (51% vs. 45%, p < 0.001) as well as hospital costs. Coronary angiographies were used more frequently (2.8% vs. 3.3%, p = 0.004) but with no corresponding change in coronary interventions.

Conclusions:

At the participating hospital, lowering of the hs-cTnT cutoff point to the 99th percentile decreased admissions and hospital costs but did not result in any apparent prognostic or treatment benefits for the patients.

Place, publisher, year, edition, pages
2017. Vol. 24, no 6, p. 612-622
Keywords [en]
high-sensitivity troponin T, hs-cTnT, 99th percentile, mortality, hospital admissions
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-340328DOI: 10.5603/CJ.a2017.0079ISI: 000419183400004PubMedID: 28695975OAI: oai:DiVA.org:uu-340328DiVA, id: diva2:1178755
Available from: 2018-01-30 Created: 2018-01-30 Last updated: 2018-01-30Bibliographically approved

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