Switching to a cardiac troponin T assay reduced low-risk classification from 62% to 26% in females and 53% to 11% in males, increasing hospital admissions (aOR 2.82).
Does switching from a high-sensitivity cardiac troponin I to a cardiac troponin T assay affect hospital admission and clinical outcomes in patients with suspected acute coronary syndrome?
Switching from high-sensitivity cardiac troponin I to troponin T significantly reduced the proportion of patients identified as low risk, leading to increased hospital admissions without improving 1-year clinical outcomes.
Absolute Event Rate: 0% vs 0%
Abstract Background High-sensitivity cardiac troponin is used to risk stratify patients with suspected acute coronary syndrome in accelerated diagnostic pathways. Whether use of a cardiac troponin I or T assay results in differences in the proportion of patients stratified as low, intermediate or high risk and this has consequences on subsequent care and clinical outcomes has not been prospectively studied. Purpose To evaluate the impact of switching from a cardiac troponin I to a cardiac troponin T assay on the effectiveness of risk stratification, hospital admission and clinical outcomes in patients with suspected acute coronary syndrome. Methods In a prospective, interrupted, time series study, consecutive patients presenting with suspected acute coronary syndrome across three acute care hospitals were identified between October 2020 and October 2022. All sites changed from a high-sensitivity cardiac troponin I to a high-sensitivity cardiac troponin T assay in October 2021. In this secondary analysis female and male patients were stratified as low, intermediate, and high risk at presentation using established low- (5 ng/L) and high-risk (sex-specific 99th percentile upper reference limits URL) thresholds. The primary outcome was hospital admission, and secondary outcomes included subsequent myocardial infarction, heart failure hospitalisation, or cardiovascular deatch at 1 year. Generalised linear regression models adjusting for age, sex, estimated glomerular filtration rate (eGFR), and comorbidities were used to compare outcomes before and after switching assays while controlling for baseline trends. Results Among 25,849 patients, 13,146 (60 47-73 years, 47% female) and 12,703 (60 47-73 years, 46% female) presented before and after the switch to cardiac troponin T. The proportion of patients identified as low risk was reduced from 62% to 26% in females and from 53% to 11% in males (P0.001 for both). The proportion identified as intermediate and high risk increased: intermediate risk from 18% to 35% in females and from 30% to 56% in males; high risk from 20% to 40% in females and from 17% to 33% in males (Figure 1, P0.001 for all). This was associated with an increase in hospital admission (adjusted odds ratio aOR 2.82, 95% confidence interval CI 2.21-3.60, P0.001). However, the proportion with subsequent myocardial infarction, heart failure hospitalisation, or cardiovascular death at 1 year (aOR 0.73, 95% CI 0.41-1.31, P=0.2967) and the proportion with all-cause death at 1 year (aOR 0.89, 95% CI 0.56-1.39, P=0.6023) were similar. Conclusions Switching from a high-sensitivity assay measuring cardiac troponin I to one measuring cardiac troponin T identified significantly fewer female and male patients as low risk, resulting in an increase in hospital admission without improving outcomes.
Li et al. (Sat,) reported a other. Switching to a cardiac troponin T assay reduced low-risk classification from 62% to 26% in females and 53% to 11% in males, increasing hospital admissions (aOR 2.82).