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Type: Journal article
Title: Randomized comparison of high-sensitivity troponin reporting in undifferentiated chest pain assessment
Author: Chew, D.
Zeitz, C.
Worthley, M.
Grantham, H.
Beltrame, J.
Arstall, M.
Coates, P.
Astley, C.
Quinn, S.
Ratcliffe, J.
Horsfall, M.
Aylward, P.
Citation: Circulation: Cardiovascular Quality and Outcomes, 2016; 9(5):542-553
Publisher: American Heart Association
Issue Date: 2016
ISSN: 1941-7705
Statement of
Derek P. Chew, Christopher Zeitz, Matthew Worthley, Hugh Grantham, John Beltrame, Margaret Arstall, Penelope Coates, Carolyn Astley, Stephen Quinn, Julie Ratcliffe, Matthew Horsfall, Philip G. Aylward
Abstract: Background: High-sensitivity troponin T (hs-TnT) assays promise greater discrimination of evolving myocardial infarction, but the impact of unguided implementation on the effectiveness of care is uncertain. Methods and Results: We evaluated the impact of hs-TnT reporting on care and outcome among chest pain patients presenting to 5 emergency departments within a multicenter randomized trial. Patients were allocated to hs-TnT reporting (hs-report) or standard reporting (std-report; Roche Elecys). The primary end point was death and new or recurrent acute coronary syndrome by 12 months. A total of 1937 patients without ST-segment elevation were enrolled between July 2011 and March 2013. The median age was 61 (interquartile range, 48-74) years, and 46.3% were women. During the index hospitalization, 1466 patients (75.7%) had maximal troponin <30 ng/L within 24 hours. Randomization to hs-report format did not alter the admission rate (hs-report: 57.7% versus std-report: 58.0%; P=0.069). There was no difference in angiography (hs-report: 11.9% versus std-report: 10.9%; P=0.479). The hs-reporting did not reduce 12-month death or new/recurrent acute coronary syndrome in the overall population (hs-report: 9.7% versus std-report: 7.2% [hazard ratio, 0.83 (0.57-1.22); P=0.362]). However, among those with troponin levels <30 ng/L, a modest reduction in the primary end point was observed (hs-report: 2.6% versus std-report: 4.4%, [hazard ratio, 0.58; 95% confidence interval, 0.34-0.1.00; P=0.050). Conclusions: High-sensitivity troponin reporting alone is associated with only modest changes in practice. Clinical effectiveness in the adoption of high-sensitivity troponin may require close coupling with protocols that guide interpretation and care. Clinical Trial Registration: URL: Unique identifier: ACTRN12611000879965.
Keywords: Acute coronary syndrome; angiography; clinical trial; myocardial infarction; troponin T
Rights: © 2016 American Heart Association, Inc
RMID: 0030051938
DOI: 10.1161/CIRCOUTCOMES.115.002488
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Appears in Collections:Medicine publications

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