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Noise versus signal: the clinical implications of an increasingly sensitive troponin assay for patients with suspected acute coronary syndrome.

Publication ,  Journal Article
Wolf, S; Kaur, R; McKeown, WP; Chan, H; Dang, A; Kuston, T; Leung, W; Purakal, J; O'Neil, BJ; Levy, P
Published in: Crit Pathw Cardiol
September 2014

OBJECTIVES: To evaluate the clinical impact of a troponin assay switch in suspected acute coronary syndromes (ACS). METHODS: Retrospective analysis of ACS cases in the 3 months before and after changing to a contemporary, higher sensitivity troponin assay. Admitting diagnosis, proportion with a positive result, initial treatment and testing, coronary artery intervention, inhospital events, and final discharge diagnosis were compared by assay group. RESULTS: Seven hundred seventy patients were included: 319 (41.4%) preassay and 451 (58.6%) postassay. Preassay change, non-ST segment elevation myocardial infarction at admission (43.0% vs. 70.5%; diff [95% confidence interval (CI)] = -27.5 [-34.2, -20.6]) was diagnosed less often, and a positive troponin was less common (33.2% vs. 72.3%; diff [95% CI] = -39.1 [-45.4, -32.2]). However, anticoagulation (53.3% vs. 42.4%; diff [95% CI] = 10.9 [3.8, 18.0]) and cardiac catheterization use were more frequent (53.9% vs. 41.9%; diff [95% CI] = 12.0 [19.0, 48.5]). There was no difference in coronary intervention (41.9% vs. 40.7%; diff [95% CI] = 1.2 [-9.0, 11.2]) by assay period. Inhospital event were rare (unstable ventricular arrhythmia = 1.2%, cardiac arrest = 3.4%, death = 4.4%) with no difference between groups. A non-ACS diagnosis at discharge was more common in the postassay group (31.6% vs. 46.5%; diff [95% CI] = 14.9 [7.9, 21.6]). CONCLUSIONS: Although non-ST segment elevation myocardial infarction diagnosis at admission and a positive troponin were more frequent postassay change, rates of anticoagulation and cardiac catheterization were lower and a non-ACS diagnosis at discharge was more common. These data suggest an evolving understanding and clinical impact of contemporary troponin assays when used in real-world settings.

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Published In

Crit Pathw Cardiol

DOI

EISSN

1535-2811

Publication Date

September 2014

Volume

13

Issue

3

Start / End Page

89 / 95

Location

United States

Related Subject Headings

  • United States
  • Troponin C
  • Retrospective Studies
  • Perioperative Care
  • Percutaneous Coronary Intervention
  • Patient Discharge
  • Outcome Assessment, Health Care
  • Myocardial Infarction
  • Monitoring, Physiologic
  • Middle Aged
 

Citation

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Chicago
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Wolf, S., Kaur, R., McKeown, W. P., Chan, H., Dang, A., Kuston, T., … Levy, P. (2014). Noise versus signal: the clinical implications of an increasingly sensitive troponin assay for patients with suspected acute coronary syndrome. Crit Pathw Cardiol, 13(3), 89–95. https://doi.org/10.1097/HPC.0000000000000020
Wolf, Sarah, Ramanjit Kaur, William Patrick McKeown, Helen Chan, Allen Dang, Trevor Kuston, Waihin Leung, John Purakal, Brian J. O’Neil, and Phillip Levy. “Noise versus signal: the clinical implications of an increasingly sensitive troponin assay for patients with suspected acute coronary syndrome.Crit Pathw Cardiol 13, no. 3 (September 2014): 89–95. https://doi.org/10.1097/HPC.0000000000000020.
Wolf S, Kaur R, McKeown WP, Chan H, Dang A, Kuston T, et al. Noise versus signal: the clinical implications of an increasingly sensitive troponin assay for patients with suspected acute coronary syndrome. Crit Pathw Cardiol. 2014 Sep;13(3):89–95.
Wolf, Sarah, et al. “Noise versus signal: the clinical implications of an increasingly sensitive troponin assay for patients with suspected acute coronary syndrome.Crit Pathw Cardiol, vol. 13, no. 3, Sept. 2014, pp. 89–95. Pubmed, doi:10.1097/HPC.0000000000000020.
Wolf S, Kaur R, McKeown WP, Chan H, Dang A, Kuston T, Leung W, Purakal J, O’Neil BJ, Levy P. Noise versus signal: the clinical implications of an increasingly sensitive troponin assay for patients with suspected acute coronary syndrome. Crit Pathw Cardiol. 2014 Sep;13(3):89–95.

Published In

Crit Pathw Cardiol

DOI

EISSN

1535-2811

Publication Date

September 2014

Volume

13

Issue

3

Start / End Page

89 / 95

Location

United States

Related Subject Headings

  • United States
  • Troponin C
  • Retrospective Studies
  • Perioperative Care
  • Percutaneous Coronary Intervention
  • Patient Discharge
  • Outcome Assessment, Health Care
  • Myocardial Infarction
  • Monitoring, Physiologic
  • Middle Aged