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Link to original content: http://pubmed.ncbi.nlm.nih.gov/38975590/
Adoption of high-sensitivity cardiac troponin for risk stratification of patients with suspected myocardial infarction: a multicentre cohort study - PubMed Skip to main page content
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. 2024 Jun 13:43:100960.
doi: 10.1016/j.lanepe.2024.100960. eCollection 2024 Aug.

Adoption of high-sensitivity cardiac troponin for risk stratification of patients with suspected myocardial infarction: a multicentre cohort study

Michael McDermott  1 , Dorien M Kimenai  1 , Atul Anand  1 , Zen Huang  2 , Andrew Houston  3 , Sophie Williams  3 , Felicity Evison  4 , Suzy Gallier  4 , Catalina Carenzo  5 , Ben Glampson  5 , Madina Hasan  6 , Alexander Robertson  6 , Thomas Phillips  7 , Cai Davis  7 , Elizabeth Sapey  4 , Erik Mayer  5 , Suzanne Mason  6 , Matthew Stammers  7 , Nicholas L Mills  1   2 ; HDRUK Regional Linked Data Driven Evidence Network
Affiliations

Adoption of high-sensitivity cardiac troponin for risk stratification of patients with suspected myocardial infarction: a multicentre cohort study

Michael McDermott et al. Lancet Reg Health Eur. .

Abstract

Background: Guidelines recommend high-sensitivity cardiac troponin to risk stratify patients with possible myocardial infarction and identify those eligible for discharge. Our aim was to evaluate adoption of this approach in practice and to determine whether effectiveness and safety varies by age, sex, ethnicity, or socioeconomic deprivation status.

Methods: A multi-centre cohort study was conducted in 13 hospitals across the United Kingdom from November 1st, 2021, to October 31st, 2022. Routinely collected data including high-sensitivity cardiac troponin I or T measurements were linked to outcomes. The primary effectiveness and safety outcomes were the proportion discharged from the Emergency Department, and the proportion dead or with a subsequent myocardial infarction at 30 days, respectively. Patients were stratified using peak troponin concentration as low (<5 ng/L), intermediate (5 ng/L to sex-specific 99th percentile), or high-risk (>sex-specific 99th percentile).

Findings: In total 137,881 patients (49% [67,709/137,881] female) were included of whom 60,707 (44%), 42,727 (31%), and 34,447 (25%) were stratified as low-, intermediate- and high-risk, respectively. Overall, 65.8% (39,918/60,707) of low-risk patients were discharged from the Emergency Department, but this varied from 26.8% [2200/8216] to 93.5% [918/982] by site. The safety outcome occurred in 0.5% (277/60,707) and 11.4% (3917/34,447) of patients classified as low- or high-risk, of whom 0.03% (18/60,707) and 1% (304/34,447) had a subsequent myocardial infarction at 30 days, respectively. A similar proportion of male and female patients were discharged (52% [36,838/70,759] versus 54% [36,113/67,109]), but discharge was more likely if patients were <70 years old (61% [58,533/95,227] versus 34% [14,428/42,654]), from areas of low socioeconomic deprivation (48% [6697/14,087] versus 43% [12,090/28,116]) or were black or asian compared to caucasian (62% [5458/8877] and 55% [10,026/18,231] versus 46% [35,138/75,820]).

Interpretation: Despite high-sensitivity cardiac troponin correctly identifying half of all patients with possible myocardial infarction as being at low risk, only two-thirds of these patients were discharged. Substantial variation in the discharge of patients by age, ethnicity, socioeconomic deprivation, and site was observed identifying important opportunities to improve care.

Funding: UK Research and Innovation.

Keywords: Data linkage; Healthcare data; Healthcare outcomes; High-sensitivity cardiac troponin; Myocardial infarction.

PubMed Disclaimer

Conflict of interest statement

NLM has received honoraria or consultancy from Abbott Diagnostics, Roche Diagnostics, Siemens Healthineers, LumiraDx, and Pyros Laboratories. All other authors have no interests to declare.

Figures

Fig. 1
Fig. 1
The primary effectiveness outcome oftheproportion discharged from the Emergency Department stratified by high-sensitivity cardiac troponin concentration into low- (<5 ng/L), intermediate- (5 ng/L to sex-specific 99th percentile), and high risk (sex-specific >99th percentile) groups by hospital site.
Fig. 2
Fig. 2
The primary safety outcome of all cause death or myocardial infarction at 30 days stratified by high-sensitivity cardiac troponin concentration into low- (<5 ng/L), intermediate- (<5 ng/L to sex-specific 99th percentile), and high risk (sex-specific >99th percentile) groups by hospital site.
Fig. 3
Fig. 3
Negative predictive value of high-sensitivity cardiac troponin I or T concentrations <5 ng/L for a) primary safety outcome (composite of all cause death or subsequent myocardial infarction) at 30 days from hospital discharge by subgroups, b)index myocardial infarction by subgroups and c)subsequent myocardial infarction within 30 days of hospital discharge.
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