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

Figures & data

Table 1. Baseline characteristics for 170,461 patients with chest pain in 14 emergency departments in Sweden in 2011 to 2016 in relation to use of high-sensitivity troponin T or conventional troponin assays.

	All patients	cTn	hs-cTnT
Total number of ED visits	2 997 111	1 077 812	1 919 299
Admissions among ED visit, n (%)	1 091 809 (36.4)	417 860 (38.8)	673 949 (35.1)
Number of patients with chest pain,	170 461	62 669	107 792
Number of men with chest pain	84 528	30 974	53 554
Number of women with chest pain	85 933	31 695	54 238
Number of visits for chest pain	256 098	89 443	166 655
Women, visits, n (%)	126 700 (49.5)	44 722 (50.0)	81 978 (49.2)
Patients admitted for chest pain, n (%)	108 162 (42.2)	40 930 (45.8)	67 232 (40.3)
MI during index visit, n (%)	15 396 (6.0)	6 180 (6.9)	9 216 (5.5)
Age (years)	63.8	65.7	62.8
Marital status
Missing	785 (0.3)	325 (0.4)	460 (0.3)
Married	121 748 (47.5)	44 225 (49.4)	77 523 (46.5)
Divorced	56 329 (22.0)	17 712 (19.8)	38 617 (23.2)
Unmarried	45 179 (17.6)	14 406 (16.1)	30 773 (18.5)
Widowed	32 067 (12.5)	12 779 (14.3)	19 288 (11.6)
Length of education
Missing	6 586 (2.6)	1 682 (1.9)	4 904 (2.9)
<10 years	73 323 (28.6)	30 999 (34.7)	42 324 (25.4)
10–12 years	104 267 (40.7)	37 396 (41.8)	66 871 (40.1)
>12 years	71 932 (28.1)	19 370 (21.7)	52 562 (31.5)
Annual disposable income
Swedish krona	397 800	351 200	422 800
Comorbidities
Prior stroke, n (%)	15 561 (6.1)	6 014 (6.7)	9 547 (5.7)
Prior MI*, n (%)	39 052 (15.2)	15 198 (17.0)	23 854 (14.3)
COPD, n (%)	16 450 (6.4)	5 475 (6.1)	10 975 (6.6)
Prior heart failure, n (%)	18 296 (7.1)	6 233 (7.0)	12 063 (7.2)
Diabetes, n (%)	30 551 (11.9)	11 421 (12.8)	19 130 (11.5)
Active cancer, n (%)	5 414 (2.1)	1 727 (1.9)	3 687 (2.2)
Chronic kidney disease, n (%)	8 112 (3.2)	2 290 (2.6)	5 822 (3.5)
Peripheral arterial disease, n (%)	750 (0.3)	404 (0.5)	346 (0.2)
Prior coronary angiography, n (%)	44 289 (17.3)	15 272 (17.1)	29 017 (17.4)
Revascularization, n (%)	39 873 (15.6)	14 530 (16.2)	25 343 (15.2)
Hospital stays within 1 year
None, n (%)	158 129 (61.7)	54 361 (60.8)	103 768 (62.3)
1, n (%)	46 352 (18.1)	16 872 (18.9)	29 480 (17.7)
2, n (%)	19 668 (7.7)	7 132 (8.0)	12 536 (7.5)
≥3, n (%)	31 959 (12.5)	11 082 (12.4)	20 877 (12.5)
Medications
Aspirin, n (%)	68 345 (26.7)	25 796 (28.8)	42 549 (25.5)
P2Y12 inhibitors, n (%)	15 553 (6.1)	6 247 (7.0)	9 306 (5.6)
Beta-blockers, n (%)	90 483 (35.3)	33 264 (37.2)	57 219 (34.3)
ACE/ARB, n (%)	88 454 (34.5)	32 588 (36.4)	55 866 (33.5)
Statins, n (%)	68 850 (26.9)	25 736 (28.8)	43 114 (25.9)
OAC, n (%)	25 028 (9.8)	9 136 (10.2)	15 892 (9.5)
Warfarin, n (%)	20 531 (8.0)	7 411 (8.3)	13 120 (7.9)
NOAC, n (%)	4 856 (1.9)	1 850 (2.1)	3 006 (1.8)

MI: myocardial infarction; COPD: chronic obstructive pulmonary disease; cTn: conventional troponin; hs-cTnT: high-sensitivity cardiac troponin T; hs-cTnI: high-sensitivity cardiac troponin I; ACE/ARB: angiotensin converting enzyme inhibitor/angiotensin receptor blocker. *Includes only MI as a primary diagnoses. P2Y12 inhibitors includes clopidogrel, ticagrelor and prasugrel. Hospital stays within 1 year includes any hospital stay within 1 year prior to the index visit.

Table 2. All-cause mortality within 1 year and missed acute coronary syndrome within 30 days of a visit for chest pain in emergency departments using hs-cTnT compared with cTn.

	All-cause mortality		Missed acute coronary syndrome
	cTn	hs-cTnT	cTn	hs-cTnT
All patients
Cases, n	4 149	6 087	118	226
Cases/visits, %	4.6%	3.7%	0.13%	0.14%
Crude^a HR, 95% CI	1.0	0.96 (0.92–1.00)	1.0	0.88 (0.70–1.10)
Adjusted^b HR, 95% CI	1.0	0.91 (0.87–0.94)	1.0	0.88 (0.70–1.11)
Men
Cases, n	2 242	3 190	68	146
Cases/visits, %	5.0%	3.8%	0.15%	0.18%
Crude^a HR, 95% CI	1.0	0.95 (0.90–1.01)	1.0	1.01 (0.75–1.35)
Adjusted^b HR, 95% CI	1.0	0.92 (0.87–0.97)	1.0	0.99 (0.74–1.33)
Women
Cases, n	1 907	2 897	50	80
Cases/visits, %	4.2%	3.4%	0.11%	0.10%
Crude^a HR, 95% CI	1.0	0.96 (0.91–1.02)	1.0	0.70 (0.49–1.00)
Adjusted^b HR, 95% CI	1.0	0.89 (0.84–0.94)	1.0	0.70 (0.48–1.00)

^aCrude HR – adjustment for sex and age was made.

^bMultivariable adjustment was made for all patient characteristics in Table 1.

Table 3. Coronary angiographies and revascularizations within 30 days in patients with chest pain in emergency departments using hs-cTnT compared with cTn.

	Coronary angiography		Revascularization
	cTn	hs-cTnT	cTn	hs-cTnT
All patients
Cases, n	6 861	13 167	4 494	8 405
Cases/total patients, %	10.9 %	12.2 %	7.2 %	7.8 %
Proportion revasc/CAG, %	N/A	N/A	66%	64%
Crude^a HR, 95% CI	1.0	1.11 (1.08–1.14)	1.0	1.08 (1.04–1.12)
Adjusted^b HR, 95% CI	1.0	1.14 (1.10–1.17)	1.0	1.12 (1.08–1.17)
Men
Cases, n	4 706	9 332	3 332	6 531
Cases/total patients, %	10.6%	11.1%	7.5%	7.8%
Proportion revasc/cai, %	N/A	N/A	71%	70%
Crude^a HR, 95% CI	1.0	1.14 (1.10–1.18)	1.0	1.13 (1.08–1.18)
Adjusted^b HR, 95% CI	1.0	1.18 (1.14–1.22)	1.0	1.17 (1.13–1.22)
Women
Cases, n	2 155	3 835	1 162	1 874
Cases/total patients, %	4.9%	4.7%	2.6%	2.3%
Proportion revasc/cai, %	N/A	N/A	54%	49%
Crude^a HR, 95% CI	1.0	1.03 (0.98–1.09)	1.0	0.94 (0.87–1.01)
Adjusted^b HR, 95% CI	1.0	1.06 (1.00–1.12)	1.0	0.98 (0.91–1.05)

CAG: coronary angiography.

^aCrude HR – adjustment for sex and age was made.

^bMultivariable adjustment was made for all patient characteristics in Table 1.