Outcomes in patients with chest pain in emergency departments using high-sensitivity versus conventional troponins

Abstract

Objectives. There is a paucity of data regarding the association between the use of high-sensitivity troponin (hs-cTn) compared with conventional troponin (cTn) and outcomes in chest pain patients in emergency departments (EDs). This study examined the impact of hs-cTnT on prognosis in chest pain patients in EDs. Design. In an observational cohort study, we included chest pain patients visiting the EDs of 14 hospitals in Sweden from 2011 to 2016. The study population was retrieved from each hospital, and information on characteristics and outcomes was collected from nationwide registries. Cox regression was used to estimate adjusted hazard ratios with 95% confidence intervals (HR, 95% CI) for (1) 1-year all-cause mortality, (2) missed acute coronary syndromes (ACSs), (3) use of coronary angiography, and (4) revascularizations within 30 days. Results. We included 170461 patients with chest pain where 62669 patients were tested with cTn while 107792 patients were tested with hs-cTnT. We found 4149 (4.6%) deaths in the cTn group and 6087 (3.7%) deaths in the hs-cTnT group. Patients in the hs-cTnT group had 9% lower mortality (0.91, 0.87–0.94), and were 14% more likely to undergo coronary angiography (1.14, 1.10–1.17), and 12% more likely to be revascularized (1.12, 1.08–1.17) than patients in the cTn group. Conclusions. Patients with chest pain visiting EDs using hs-cTnT had lower mortality and a higher likelihood of undergoing coronary angiographies and revascularizations than those using cTn. There may be a survival benefit of being tested with hs-cTnT compared with cTn in patients seeking medical attention for chest pain.

Keywords:

• High-sensitivity cardiac troponin
• chest pain
• emergency department
• outcomes; cardic troponin

Acknowledgments

The authors thank Tomas Andersson at Tomas Andersson Biostatistik AB for assistance with data management and statistical analyses. The construction of the database used in this study was sponsored by an unrestricted grant from Idorsia.

Disclosure statement

The corresponding author, on behalf of all authors, declares that all authors have completed the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Holzmann has received consultancy honoraria from Idorsia. The remaining authors declare no conflicts of interest.

Additional information

Funding

No specific funding was obtained for this study. Dr. Holzmann held research positions funded by the Swedish Heart-Lung Foundation [grant: 20170804] and the Stockholm County Council [grant: 20170686]. The sponsors had no role in the design or conduct of this study.