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Impact of the clinical introduction of high-sensitivity cardiac troponin T assay on rates of coronary angiographies and exercise stress tests in acute chest pain - Insights from an international trial

Session Poster session 6

Speaker Raphael Twerenbold

Event : ESC Congress 2014

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Cardiac Care
  • Session type : Poster Session

Authors : R Twerenbold (Basel,CH), T Reichlin (Boston,US), M Reiter (Basel,CH), P Haaf (Basel,CH), M Rubini Gimenez (Basel,CH), K Wildi (Basel,CH), S Osswald (Basel,CH), C Mueller (Basel,CH)

R. Twerenbold1 , T. Reichlin2 , M. Reiter1 , P. Haaf1 , M. Rubini Gimenez1 , K. Wildi1 , S. Osswald1 , C. Mueller1 , 1University Hospital Basel - Basel - Switzerland , 2Brigham and Women's Hospital, Department of Medicine, Cardiovascular Division - Boston - United States of America ,

European Heart Journal ( 2014 ) 35 ( Abstract Supplement ), 983-984

Purpose: With the clinical introduction of more sensitive cardiac troponin (cTn) assays, concerns about potential higher rates of false positives leading to an increased number of clinically not indicated coronary angiographies and exercise stress tests arose. On the other hand, the increased sensitivity potentially improves the early rule out of acute myocardial infarction (AMI), decreasing the need for further stress tests.

Methods: We conducted a prospective, international diagnostic study to compare the incidence of coronary angiographies and exercise stress tests before and after the introduction of Roche high-sensitivity (hs) cTnT assay, replacing a less sensitive, conventional cTnT assay. A total of 2631 consecutive patients presenting with symptoms suggestive of AMI to the emergency department (ED) of three hospitals were included. Coronary angiographies and cardiac stress tests were only considered for this analysis if they were performed during the index visit or within the following three months.

Results: During the first phase using a conventional cTnT assay, 26% (387 out of 1513) of all patients underwent coronary angiography as compared to 25% (284 out of 1118) patients after the introduction of the hs-cTnT assay (p=0.919 for comparison). The percentage of angiographic findings showing normal vessels (10% before vs. 7% after the introduction of hs-cTnT, p=0.431) or just mild coronary sclerosis (4% vs. 6%, respectively) did not differ significantly between the two phases (p=0.431). Cardiac stress tests were markedly less frequent after the introduction of the hs-cTnT-assay (28% vs. 19%, respectively, p<0.001). Median time spent on the ED until discharge could be reduced significantly for out-patients after the introduction of hs-cTnT (359 minutes before vs. 277 minutes after hs-cTnT, p<0.001).

Conclusions: As compared to times using a conventional, less sensitive cTnT assay, the introduction of a hs-cTnT assay does neither result in higher rates of coronary angiographies nor in an increased number of normal or just mild angiographic findings among patients presenting with acute chest pain to the ED. However, the use of hs-cTnT reduces the median length of stay on the and seems to substantially improve the early rule-out of AMI by nearly halving the rates of subsequent exercise stress tests.

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