High sensitivity troponin: Does the 50% delta change alter clinical outcomes in chest pain presentations to the emergency room?. (1st April 2015)

• Record Type: Journal Article
• Authors: Sajeev, Jithin K.; New, Gishel; Roberts, Louise; Menon, Siddharth K.; Gunawan, Florence; Wijesundera, Piyumi; Teh, Andrew W.
• Is Part Of: International journal of cardiology. Volume 184(2015)
• Page Start: 170
• Page End: 174
• Publication Date: 2015-04-01
• Subjects: Troponin -- Acute coronary syndrome -- Myocardial infarction -- High sensitivity -- Delta; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2015.01.074
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The National Heart Foundation (NHF) and Cardiac Society of Australia and New Zealand (CSANZ) Acute Coronary Syndrome (ACS) guidelines recommend the use of a high sensitivity troponin assay (hsTrop) in the assessment of patients presenting with ACS. A troponin delta of 50% compared with the previously recommended 20% is advocated by the guidelines to aid in the clinical diagnosis of ACS. We sought to determine the clinical impact of the updated recommendation to use 50% troponin delta for patients presenting with chest pain to the emergency department. Method: We retrospectively collected data for all patients > 18 years presenting with chest or abdominal pain with a hsTrop test performed between January–June 2012. Patients with a STEMI, lacked serial hsTrop, were on dialysis or had trauma-related pain were excluded. Results: Of the 1054 eligible patients, 422 (40%) with serial hsTrop had at least one abnormal troponin (> 14 ng/ml). 73 (6.9%) fell within 20–50%. Twenty-seven had clinical or ECG evidence suggestive of ACS and were referred for further cardiac investigations. Of the remainder, five patients were medically managed for ACS, 38 patients with non-cardiac chest pain had no further tests. At 1 year follow-up, of the patients that did not undergo further investigations, 6 patients represented with ACS; there was no cardiac mortality. Conclusion: Our data showed a number of patients that would be potentially missed with the implementation of a 50% troponin. However, this loss of sensitivity was mitigated by the use of clinical acumen.