High-Sensitivity Troponin Assay Use Does Not Appear to Increase Diagnostic Procedures

LONDON, England—Real-world use of a high-sensitivity cardiac troponin T (hs-cTnT) assay does not lead to diagnostic overuse in patients with suspected ACS, according to results of a registry study presented September 1, 2015, at the European Society of Cardiology Congress.

Kai M. Eggers, MD, of Uppsala Clinical Research Center (Uppsala, Sweden), and colleagues used data from the nationwide SWEDEHEART registry to look restrospectively at the clinical impact of implementation of the hs-cTnT assay at Swedish coronary care units (CCUs), which have seen a sharp rise in use of the test since 2009. The study compared the 1-year period before the assay was introduced with the 1 year after  implementation.Take Home: High-Sensitivity Troponin Assay Use Does Not Appear to Increase Diagnostic Procedures

The study included 37,710 patients (mean age 70 years; 60% men). The baseline characteristics of patients changed from the year before to after introduction, including increases in rates of certain cardiovascular risk factors (hypertension, diabetes, and hyperlipidemia) and in the proportion with a history of previous MI or previous PCI/CABG.

In terms of discharge diagnoses, there was an increase between the 2 time periods in the number of patients with MI and unstable angina, and a decrease in the number of patients with noncardiac or unspecified diagnoses. In addition, more troponin-positive patients with conditions other than ACS were admitted in the latter time period.

According to Dr. Eggers, this likely reflects “the improved sensitivity of the high-sensitivity assay [and] also increased likelihood for non-ACS patients to be admitted with troponin levels regarded as elevated following the lowering of the diagnostic cutoff to the 99th percentile.”

No Signs of Inappropriate Resource Use

Multivariate analysis showed increased use of revascularization in troponin-positive patients after assay implementation, driven by more patients with an ACS diagnosis. Use of heparins and antiplatelets at discharge decreased in troponin-positive patients, driven by a decline in use of these agents among those without ACS. Furthermore, there was an increase in use of ACE inhibitors and angiotensin receptor blockers (ARBs) at discharge, driven by more frequent use in patients with and without ACS. Use of the assay did not affect statin status at discharge (table 1).

High-Sensitivity Troponin Assay Use Does Not Appear to Increase Diagnostic Procedures

“Following implementation of a high-sensitivity assay we found no indication of an inappropriate overuse of diagnostic procedures and treatments,” Dr. Eggers concluded. “Instead, a change in the treatment pattern was noted depending on and considering the cause of troponin elevation.”


Eggers KM. Consequences of the implementation of a high-sensitivity cardiac troponin assay at   Swedish coronary care units. Presented at: European Society of Cardiology Congress; September 1, 2015; London, England. 


  • Dr. Eggers reports receiving honoraria from Abbott Laboratories, AstraZeneca, and Siemens Healthcare, and serving as a consultant to Abbott Laboratories and Fiomi Diagnostics.

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