Initiation of hs-troponin assay in ED leads to more positive results in patients with chest pain

The introduction of high-sensitive (hs) troponin assay in the emergency department (ED) has resulted in an increased percentage of positive hs-troponin tests in patients with noncardiac chest pain, but the average number of diagnostic tests has dwindled in those with chest pain presenting to the ED, suggesting greater confidence of clinicians in their diagnosis, a study has found.

Analysis was carried out using data from 1,274 patients (standard, n=597, 46.9 percent; hs-troponin, n=677, 53.1 percent). An increase in the number of patients with non-ST-segment elevation myocardial infarction was observed (hs-troponin 14.9 percent vs 9.7 percent), while the proportion in unstable angina (1.5 percent to 4.0 percent) and other cardiac illnesses (8.1 percent to 11.7 percent) decreased.

The proportion of positive hs-troponin was higher (6.1 percent vs 2.0 percent) but that of noncardiac chest pain illnesses remained the same (67 percent). In addition, the average number of additional tests per person fell in both troponin positive (20 to 1.7 test per patients; p=0.02) and troponin-negative patients (3.1 to 2.8 tests per patient; p<0.0001).

This study evaluated the impact of the introduction of the hs-troponin assay on the discharge diagnoses and the number of diagnostic tests in patients presenting with chest pain in a real-life setting in an ED. The authors performed a retrospective chart review of patients presenting with chest pain to one of the largest hospitals in Switzerland and compared the standard troponin period (December 2009 to November 2010) with the hs-troponin period (December 2010 to December 2011).