Effect of change of high-sensitivity troponin I assay on emergency department diagnosis and disposition of patients with possible acute coronary syndrome

IF 1.7 4区医学 Q2 EMERGENCY MEDICINE

Emergency Medicine Australasia Pub Date : 2025-03-04 DOI:10.1111/1742-6723.70022

John W Pickering PhD, Scott Kelland MBChB, Otis Williams BMedSci(Hons), Jamin Kim MBChB, Sally Aldous MD, Laura R Joyce MBChB, Martin P Than MBBS

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引用次数: 0

Abstract

Objective

Changing cardiac troponin (cTn) assays may affect a hospital's admission and myocardial infarction rates. The effect of changing from a contemporary to high-sensitivity (hs) cTnI assay has been well described, but the real-life impact on disposition and diagnosis of changing from one hs-cTnI assay to another has not.

Methods

All patients who received a troponin measurement in the ED during 16 weeks were adjudicated to identify those the attending physician investigated for possible acute coronary syndrome (ACS) and for clinical outcomes. The Abbott ARCHITECT hs-cTnI assay was in use for the first 8 weeks, followed by the Beckman Coulter hs-cTnI assay for the second 8 weeks.

Results

Fewer patients were investigated with the Abbott assay (2213), than the Beckman assay (2683). A larger proportion were investigated for ACS in the Abbott (64.8%) than the Beckman (60.3%) arm. Among those investigated for ACS the rate of myocardial infarction decreased on changing from Abbott (12.8%) to Beckman (8.8%). Adjusted odds of a myocardial infarction were lower for the Beckman arm, Odds Ratio 0.69 (95% CI 0.55 to 0.88). A lower proportion of Abbott than Beckman had myocardial injury (at least one ED cTnI ≥ upper reference limit) 26.4% compared with 29.8%. The proportion admitted to hospital decreased from the Abbott arm (42.5%) to the Beckman arm (36.8%).

Conclusions

A change in cTnI assay resulted in a decreased rate of myocardial infarction and admission despite an increase in rate of myocardial injury among patients investigated for ACS.

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来源期刊

Emergency Medicine Australasia 医学-急救医学

CiteScore

3.70

自引率

13.00%

发文量

217

审稿时长

6-12 weeks

期刊介绍： Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM), and publishes original articles dealing with all aspects of clinical practice, research, education and experiences in emergency medicine. Original articles are published under the following sections: Original Research, Paediatric Emergency Medicine, Disaster Medicine, Education and Training, Ethics, International Emergency Medicine, Management and Quality, Medicolegal Matters, Prehospital Care, Public Health, Rural and Remote Care, Technology, Toxicology and Trauma. Accepted papers become the copyright of the journal.