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High-sensitivity versus conventional troponin for management and prognosis assessment of patients with acute chest pain
  1. Juan Sanchis1,
  2. Sergio García-Blas1,
  3. Luis Mainar1,
  4. Anna Mollar1,
  5. Lidia Abellán2,
  6. Silvia Ventura1,
  7. Clara Bonanad1,
  8. Luciano Consuegra-Sánchez3,
  9. Mercé Roqué4,
  10. Francisco J Chorro1,
  11. Eduardo Núñez1,
  12. Julio Núñez1
  1. 1Cardiology Department, Medicine Department, University Clinic Hospital, INCLIVA, València University, Valencia, Spain
  2. 2Clinical Biochemical Department, University Clinic Hospital, València, Spain
  3. 3Cardiology Department, University Santa Lucia Hospital, Cartagena, Spain
  4. 4Cardiology Department, Clinic Hospital, Barcelona, Spain
  1. Correspondence to Professor Juan Sanchis, Cardiology Department, University Clinic Hospital, Blasco Ibáñez 17, Valencia 46010, Spain; sanchis_juafor{at}gva.es

Abstract

Objectives High-sensitivity troponin (hs-cTn) is substituting conventional cTn for evaluation of chest pain. Our aim was to assess the impact on patient management and outcome.

Methods A total of 1372 consecutive patients presenting at the emergency department with non-ST-elevation acute chest pain were divided into two periods according to the cTn assay used, conventional (n=699, March 2008 to July 2010) or hs-cTn (n=673, November 2010 to March 2013). Management policies were similar and according to guidelines. The primary endpoint was major adverse cardiac events (MACE) at 6 months (death, myocardial infarction, readmission by unstable angina or postdischarge revascularisation).

Results There were minor differences in baseline characteristics. In the hs-cTn period, more patients elevated cTn (73% vs 37%, p=0.0001) leading to more coronary angiograms (77% vs 55%, p=0.0001) and revascularisations (45% vs 31%, p=0.0001); conversely, fewer patients were initially assigned to exercise testing (14% vs 36%, p=0.0001) and, therefore, discharged early after a negative result (7% vs 22%, p=0.0001). At 6 months, 135 patients suffered MACE, including 54 deaths. After adjusting for a Propensity Score, hs-cTn use was not significantly associated with MACE (HR=0.99; 95% CI 0.70 to 1.41; p=0.98) or mortality (HR=1.02; 95% CI 0.59 to 1.77; p=0.95), though the risk of longer hospitalisation stay increased at the index episode (OR=1.35, 95% CI 1.07 to 1.71, p=0.02).

Conclusions hs-cTn simplified chest pain triage on avoiding a more complex evaluation with non-invasive tests in the chest pain unit, but prompted longer hospitalisations and more invasive procedures without impacting on the 6-month outcomes.

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