title: Impact of high-sensitivity Troponin T on hospital admission, resources utilization, and outcomes.
abstract: OBJECTIVE
  The use of high-sensitivity cardiac Troponin T (hs-cTnT) assay might lead to overdiagnosis and overtreatment of Acute Coronary Syndromes (ACS). This study assessed the epidemiological, clinical and prognostic impact of introducing hs-cTnT in the everyday clinical practice of an Emergency Department.
  
  
  RESULTS
  We compared all consecutive patients presenting with suspected ACS at the Emergency Department, for whom troponin levels were measured. In particular, we considered 597 patients presenting during March 2010, when standard cardiac Troponin T (cTnT) assay was used, and 629 patients presenting during March 2011, when hs-cTnT test was used. Patients with suspected ACS and troponin levels above the 99th percentile (Upper Reference Limit, URL) significantly increased when using an hs-cTnT assay (17.2% vs. 37.4%, p< 0.001). Accordingly, also the mean GRACE risk score increased (124.2 ± 37.2 vs. 136.7 ± 32.2; p< 0.001). However, the final diagnosis of Acute Myocardial Infarction (AMI) did not change significantly (8.7% vs. 6.8%, p=0.263) by using a rising and/or falling pattern of hs-cTnT (change ≥ 50% or ≥ 20% depending on baseline values). In addition, no significant differences were found between the two study groups with respect to in-hospital (2.7% vs. 1.9%, p=0.366) and 1-year mortality (9.8% vs. 7.6%, p=0.216).
  
  
  CONCLUSIONS
  We did not observe overdiagnosis and overtreatment issues in presenters with suspected ACS managed by appropriate changes in hs-cTnT levels, despite the increase in the number of patients presenting with abnormal troponin levels. This occurred without a rise in short-term and mid-term mortality.
authors.affiliation: Institute of Cardiology, Cardio-Thoraco-Vascular Department, Sant'Orsola-Malpighi Hospital and University of Bologna, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Corsini
authors.affiliation: Institute of Cardiology, Cardio-Thoraco-Vascular Department, Sant'Orsola-Malpighi Hospital and University of Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Vagnarelli
authors.affiliation: Institute of Cardiology, Cardio-Thoraco-Vascular Department, Sant'Orsola-Malpighi Hospital and University of Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Bugani
authors.affiliation: Institute of Cardiology, Cardio-Thoraco-Vascular Department, Sant'Orsola-Malpighi Hospital and University of Bologna, Italy.
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Bacchi Reggiani
authors.affiliation: Institute of Cardiology, Cardio-Thoraco-Vascular Department, Sant'Orsola-Malpighi Hospital and University of Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Semprini
authors.affiliation: Institute of Cardiology, Cardio-Thoraco-Vascular Department, Sant'Orsola-Malpighi Hospital and University of Bologna, Italy.
authors.forename: Samuele
authors.initials: S
authors.lastname: Nanni
authors.affiliation: Institute of Cardiology, Cardio-Thoraco-Vascular Department, Sant'Orsola-Malpighi Hospital and University of Bologna, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Cinti
authors.affiliation: Institute of Cardiology, Cardio-Thoraco-Vascular Department, Sant'Orsola-Malpighi Hospital and University of Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Norscini
authors.affiliation: Emergency and Surgical-Transplantation Department, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Vannini
authors.affiliation: Haematology, Oncology and Laboratory Medicine Department, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Beltrandi
authors.affiliation: Emergency and Surgical-Transplantation Department, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cavazza
authors.affiliation: Institute of Cardiology, Cardio-Thoraco-Vascular Department, Sant'Orsola-Malpighi Hospital and University of Bologna, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
authors.affiliation: Institute of Cardiology, Cardio-Thoraco-Vascular Department, Sant'Orsola-Malpighi Hospital and University of Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
authors.affiliation: Institute of Cardiology, Cardio-Thoraco-Vascular Department, Sant'Orsola-Malpighi Hospital and University of Bologna, Italy giovanni.melandri@aosp.bo.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Melandri
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: Acute coronary syndrome; cardiac Troponin T; chest pain; emergency department; myocardial infarction