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Impact of clinical introduction of high-sensitive cardiac troponin assays on incidence of coronary angiography and exercise stress testing

Session Poster Session 5

Speaker Raphael Twerenbold

Event : ESC Congress 2013

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

Authors : R Twerenbold (Basel,CH), M Mueller (Basel,CH), R Hoeller (Basel,CH), T Reichlin (Basel,CH), P Haaf (Basel,CH), T Hochgruber (Basel,CH), M Rubini-Gimenez (Basel,CH), S Sou (Basel,CH), S Osswald (Basel,CH), C Mueller (Basel,CH)

Authors:
R. Twerenbold1 , M. Mueller1 , R. Hoeller1 , T. Reichlin1 , P. Haaf1 , T. Hochgruber1 , M. Rubini-Gimenez1 , S. Sou1 , S. Osswald1 , C. Mueller1 , 1University Hospital Basel - Basel - Switzerland ,

Citation:
European Heart Journal ( 2013 ) 34 ( Abstract Supplement ), 733

Purpose: With the clinical introduction of more sensitive cardiac troponin (cTn) assays, concerns arose about potential higher rate of false positives leading to an increased number of clinically not indicated coronary angiographies and exercise stress tests.

Methods: We conducted a prospective observational study to compare the incidence of coronary angiographies and exercise stress tests before and after the introduction of a high-sensitive (hs) cTnT assay, replacing a less sensitive, conventional cTnT assay. A total of 1768 consecutive patients presenting with symptoms suggestive of acute myocardial infarction (AMI) to the emergency department (ED) of a Swiss university hospital were included. Coronary angiographies and exercise 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 the conventional cTnT assay, a total of 315 out of 1120 patients (28,1%) underwent coronary angiography as compared to 177 out of 648 patients (27,3%) after the introduction of the hs-cTnT assay (p=0.71 for comparison). The incidence of normal angiographic findings without any atherosclerosis (9,2% before vs. 6.8% after the introduction of hs-cTnT, p=0.35) or just mild coronary sclerosis (stenosis < 50%) (3.5% vs. 6.8%, respectively, p=0.10) did not differ significantly between the two groups.

Exercise stress tests were markedly less frequent after the introduction of the hs-cTnT-assay (31,5% vs. 17,3%, p<0.001).

Median stay in the hospital could be reduced significantly after the introduction of high-sensitive cTnT (2 day [IQR 1-7] before vs. 1 day [IQR 1-5] after hs-cTnT-introduction, p=0.002).

Conclusions: The introduction of a hs-cTn assay does neither result in a higher incidence of coronary angiographies nor in an increased incidence of normal angiographic findings whereas it reduces the median length of stay in the hospital among patients presenting with acute chest pain to the ED. Of note, the use of hs-cTnT nearly halves the incidence of subsequent exercise stress testing.

ClinicalTrials.gov number, NCT00470587.

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