Clinical Impact of Using a More Sensitive Troponin Assay in Patients with Acute Chest Pain.

BACKGROUND: More sensitive troponin assays have the potential to better evaluate the patients with suspected acute coronary syndrome (ACS). Meanwhile, they may result in avoidable diagnostic testing.

HYPOTHESIS: Our aim was to determine the clinical impact of implementing a more sensitive cardiac troponin I (cTnI) assay in patients with acute non-traumatic chest pain presenting to the emergency department (ED).

METHODS: This is a pre-post cohort study. A total of 1201 consecutive patients with acute non-traumatic chest pain or equivalent ischemic symptoms suggestive of ACS were allocated to two groups according to the cTnI assay used. The outcomes included the ED length of stay (LOS), hospital admission rate, the use of procedures and the incidence of major adverse cardiac events (MACE) at 30 days.

RESULTS: The introduction of the more sensitive troponin assay shortened ED LOS (OR 0.39, 95% CI 0.28 to 0.54) regarding patients discharged home directly, increased the hospital admission rate (OR 1.43, 1.12 to 1.84), the use of echocardiography (OR 1.58, 1.22 to 2.06), coronary computed tomography angiography (OR 1.78, 1.04 to 3.06), coronary angiography (OR 1.53, 1.10 to 2.12) and percutaneous coronary intervention (OR 2.42, 1.58 to 3.70) regarding patients discharged or admitted. The incidence of MACE did not decrease significantly (OR 0.61, 0.27 to 1.37).

CONCLUSIONS: The introduction of the more sensitive troponin assay appeared to result in less time spent in the ED regarding patients discharged home directly, but prompted more hospitalizations and procedures without impacting the incidence of MACE.