Outcomes in Patients With Chest Pain Discharged After Evaluation Using a High-Sensitivity Troponin T Assay

• Published in: Journal of the American College of Cardiology 2017-05, Vol.69 (21), p.2622-2630
• Main Authors: Nejatian, Atosa, MD, Omstedt, Åsa, MD, Höijer, Jonas, MSc, Hansson, L.O., MD, PhD, Djärv, Therese, MD, PhD, Eggers, Kai M., MD, PhD, Svensson, Per, MD, PhD
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Assaying; Biomarkers - blood; Calcium-binding protein; Cardiology; Cardiovascular; Cardiovascular disease; Cardiovascular diseases; cardiovascular risk; Chest; Chest Pain - blood; Chest Pain - epidemiology; Chest Pain - etiology; Confidence intervals; discharge; Electrocardiography; emergency department; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Evaluation; Family medical history; Female; Health care; Heart attacks; Heart diseases; Hospitals; Humans; Incidence; Internal Medicine; major adverse cardiac event; Male; Medicin och hälsovetenskap; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - diagnosis; Myocardial Infarction - epidemiology; Pain; Patient Discharge; Patients; Prognosis; Registries; Retrospective Studies; Risk assessment; Sensitivity; Sensitivity analysis; Survival Rate - trends; Sweden - epidemiology; Troponin; Troponin T; Troponin T - blood
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2017.03.586

Abstract Background Most patients with chest pain are discharged from the emergency department (ED) with the diagnosis “unspecified chest pain.” It is unknown if evaluation with a high-sensitivity troponin T (hsTnT) assay affects prognosis in this large population. Objectives The aim was to investigate whether the introduction of an hsTnT assay is associated with reduced incidence of major adverse cardiac events (MACEs) and cardiovascular (CV) risk profile in patients with chest pain discharged from the ED. Methods The study included 65,696 patients with “unspecified chest pain” discharged from 16 Swedish hospital EDs between 2006 and 2013 in which an hsTnT assay was introduced as the clinical routine. Patients evaluated with a conventional and an hsTnT assay were compared regarding the occurrence of 30-day MACE and CV risk profile based on information from national registries. Patients directly discharged and those discharged after an initial admission were analyzed separately. Results Fewer directly discharged patients experienced a MACE when evaluated with an hsTnT compared with a conventional assay (0.6% vs. 0.9%; odds ratio [OR]: 0.7; 95% confidence interval [CI]: 0.57 to 0.83). In contrast, more patients discharged after an initial admission experienced a MACE when evaluated with an hsTnT (7.2% vs. 3.4%; OR: 2.18; 95% CI: 1.76 to 2.72). Admitted patients had a higher general CV risk profile when evaluated with hsTnT, whereas directly discharged patients had a lower general CV risk profile with the same test. Conclusions Patients directly discharged from the ED with unspecified chest pain experienced fewer MACEs and had a better risk profile when evaluated with hsTnT. Our findings suggest that more true at-risk patients were identified and admitted. The implementation of hsTnT assays in Swedish hospitals has improved evaluations in the ED.