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Observational Study
. 2021 Jun 29;77(25):3160-3170.
doi: 10.1016/j.jacc.2021.04.050. Epub 2021 May 3.

Clinical Impact of High-Sensitivity Cardiac Troponin T Implementation in the Community

Olatunde Ola  1 , Ashok Akula  1 , Laura De Michieli  2 , Marshall Dworak  3 , Erika Crockford  4 , Ronstan Lobo  5 , Nicholas Rastas  3 , Jonathan D Knott  6 , Ramila A Mehta  7 , David O Hodge  8 , Eric Grube  9 , Swetha Karturi  10 , Scott Wohlrab  11 , Tahir Tak  3 , Charles Cagin  3 , Rajiv Gulati  5 , Allan S Jaffe  12 , Yader Sandoval  13
Affiliations
Observational Study

Clinical Impact of High-Sensitivity Cardiac Troponin T Implementation in the Community

Olatunde Ola et al. J Am Coll Cardiol. .

Abstract

Background: Limited U.S. data exist regarding high-sensitivity cardiac troponin (cTn) implementation.

Objectives: This study sought to evaluate the impact of high-sensitivity cardiac troponin T (cTnT) implementation.

Methods: Observational U.S. cohort study of emergency department (ED) patients undergoing measurement of cTnT during the transition from 4th (pre-implementation March 12, 2018, to September 11, 2018) to 5th generation (Gen) cTnT (post-implementation September 12, 2018, to March 11, 2019). Diagnoses were adjudicated following the Fourth Universal Definition of Myocardial Infarction (MI). Resources evaluated included length of stay, hospitalizations, and cardiac testing.

Results: In this study, 3,536 unique patients were evaluated, including 2,069 and 2,491 ED encounters pre- and post-implementation. Compared with 4th Gen cTnT, encounters with ≥1 cTnT >99th percentile increased using 5th Gen cTnT (15% vs. 47%; p < 0.0001). Acute MI (3.3% vs. 8.1%; p < 0.0001) and myocardial injury (11% vs. 38%; p < 0.0001) increased. Although type 1 MIs increased (1.7% vs. 2.9%; p = 0.0097), the overall MI increase was largely due to more type 2 MIs (1.6% vs. 5.2%; p < 0.0001). Women were less likely than men to have MI using 4th Gen cTnT (2.3% vs. 4.4%; p = 0.008) but not 5th Gen cTnT (7.7% vs. 8.5%; p = 0.46). Overall length of stay and stress testing were reduced, and angiography was increased (all p < 0.05). Among those without cTnT increases, there were more ED discharges and a reduction in length of stay, echocardiography, and stress tests (all p < 0.05).

Conclusions: High-sensitivity cTnT implementation resulted in a marked increase in myocardial injury and MI, particularly in women and patients with type 2 MI. Despite this, except for angiography, overall resource use did not increase. Among those without cTnT increases, there were more ED discharges and fewer cardiac tests.

Keywords: cardiac troponin; myocardial infarction; myocardial injury; resource utilization.

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Conflict of interest statement

Funding Support and Author Disclosures This publication was made possible in part by the Mayo Clinic CTSA through grant UL1TR002377 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health. Dr. Jaffe has consulted or presently consults for most of the major diagnostics companies, including Beckman, Abbott, Siemens, ET Healthcare, Roche, Radiometer, Sphingotec, Amgen, and Novartis. Dr. Sandoval has previously served on the Advisory Boards for Roche Diagnostics and Abbott Diagnostics without personal compensation; and has also been a speaker without personal financial compensation for Abbott Diagnostics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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