High-sensitivity troponin reporting modestly affects changes in practice, outcomes
High-sensitivity troponin reporting only produces modest changes in clinical practice, but routine use may improve late outcomes in certain patients, researchers reported in Circulation: Cardiovascular Quality and Outcomes.
The researchers conducted a prospective, multicenter trial to compare serum troponin levels using a standard troponin T assay with levels using a high-sensitivity assay. Patients (median age, 61 years; interquartile range, 48-74; 46% women) who presented to the ED with chest pain or suspected ACS at five metropolitan hospitals in Adelaide, Australia, were randomly assigned either assay.
The primary outcome was a composite endpoint of all-cause mortality and new or recurrent ACS. Follow-up lasted for 12 months.
Overall, 1,937 patients were included in the analysis (high-sensitivity group, 973; standard group, 964); 73.4% of the patients were at intermediate or high risk and 75.7% had a peak troponin level less than 30 ng/L within 24 hours.
Assay assignment did not affect the admission rate (high-sensitivity report, 57.7%; standard report, 58%; P = .069); or the decision to perform angiography (high-sensitivity report, 11.9%; standard report, 10.9%; P = .479), according to the researchers.
In addition, no reduction was observed in all-cause mortality or new or recurrent ACS (high-sensitivity report, 9.7%; standard report, 7.2%; HR = 0.83; 95% CI, 0.57-1.22; P = 0.362).
There was, however, a small reduction in the primary endpoint for patients with troponin levels less than 30 ng/L (high-sensitivity report, 2.6%; standard report, 4.4%; HR = 0.58; 95% CI, 0.34-1; P = .05), the researchers wrote.
“Adoption of high-sensitivity troponin testing is likely to require coupling with management protocols that guide interpretation and care if the benefits of greater diagnostic discrimination are to be harnessed. Such protocols should be validated in comparative clinical trials,” the researchers wrote. – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures.