Abstract
Objective
The study sought to evaluate changes in mortality and resource utilization in patients
with low level troponin elevations following a reduction in the cutoff for normal
troponin I (TnI) from 0.5 ng/mL to the 99th percentile (0.06 ng/mL).
Methods
This was an interrupted time series comparing emergency department (ED) patients with
possible acute coronary syndrome (ACS) and TnI values 0.06–0.5 ng/mL before and after
an institutional decrease in the TnI cutoff. The primary outcome was overall mortality
at 90 days. Secondary outcomes included rates of rehospitalization, subsequent ACS,
and coronary intervention within 90 days, as well as rates of anticoagulation, cardiology
consultation, cardiac testing, and coronary intervention during the index visit. Outcomes
for the pre-cutoff change group (control) and post-cutoff change group (post) were
compared using tests of proportions and odds ratios.
Results
The study included a total of 1058 subjects with 529 in each cohort. No significant
differences in 90 day outcomes were observed between groups, including mortality (13.2%
post vs 14.1% control, OR 0.93 [95% CI: 0.65–1.34], p = 0.705). During the index visit, the post-group demonstrated higher rates of cardiology
consultation (55.4% vs 41.2%, OR 1.77 [1.39–2.26], p < 0.0001) and cardiac stress testing (16.4% vs 10.6%, OR 1.66 [1.16–2.38], p = 0.006), but no significant differences in coronary intervention or short-term mortality
were observed.
Conclusion
A reduction in the TnI cutoff to the 99th percentile did not change mortality or rates
of coronary intervention in ED patients with low level troponin elevations, but significantly
increased the use of cardiology resources.
Keywords
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Article Info
Publication History
Published online: February 03, 2018
Accepted:
February 2,
2018
Received in revised form:
February 1,
2018
Received:
October 29,
2017
Footnotes
☆Conflicts of Interest/Funding/Disclosures: None.
☆Prior Presentations:
- 1.SAEM Mid-Atlantic Regional Meeting; Philadelphia, PA (February 2014).
- 2.SAEM Annual Meeting; Dallas, TX (April 2014).
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
