title: Availability of highly sensitive troponin assays and acute coronary syndrome care: insights from the SNAPSHOT registry.
abstract: OBJECTIVE
  To examine differences in care and inhospital course of patients with possible acute coronary syndrome (ACS) in Australia and New Zealand based on whether a highly sensitive (hs) troponin assay was used at the hospital to which they presented.
  
  
  METHODS
  A snapshot study of consecutive patients presenting to hospitals in Australia and New Zealand from 14 to 27 May 2012 with possible ACS.
  
  
  METHODS
  Rates of major adverse cardiac events (inhospital death, new or recurrent myocardial infarction, stroke, cardiac arrest or worsening heart failure); association between assay type and outcome (via propensity score matching and a generalised estimating equation [GEE]; averages of the predicted outcomes among patients who were treated with and without the availability of an hs assay (via inverse probability-weighting [IPW] with regression-adjusted estimators).
  
  
  RESULTS
  4371 patients with possible ACS were admitted to 283 hospitals. Over half of the hospitals (156 [55%]) reported using the hs assay and most patients (2624 [60%]) had hs tests (P = 0.004). Use of the hs assay was independent of hospital coronary revascularisation capability. Patients tested with the hs assay had more non-invasive investigations (exercise tests, stress echocardiography, stress nuclear scans, and computed tomography coronary angiography) than those tested with the sensitive assay. However, there were no differences between the groups in rates of angiography or revascularisation. All adjusted analyses showed a consistently lower rate of inhospital events, including recurrent heart failure in patients for whom the hs assay was used (GEE odds ratio, 0.75; 95% CI, 0.60-0.94; P = 0.014); IPW analysis showed a 2.3% absolute reduction in these events with the use of the hs assay (P = 0.018).
  
  
  CONCLUSIONS
  Use of hs troponin testing of patients hospitalised with possible ACS was associated with an increased rate of non-invasive cardiac investigations and fewer inhospital adverse events.
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. Louise.cullen@health.qld.gov.au.
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
authors.affiliation: Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: John K
authors.initials: JK
authors.lastname: French
authors.affiliation: University of Western Australia, Perth, WA, Australia.
authors.forename: Tom G
authors.initials: TG
authors.lastname: Briffa
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Redfern
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors.forename: Christopher J K
authors.initials: CJ
authors.lastname: Hammett
authors.affiliation: Concord Repatriation General Hospital, Sydney, NSW, Australia.
authors.forename: David B
authors.initials: DB
authors.lastname: Brieger
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors.forename: William A
authors.initials: WA
authors.lastname: Parsonage
authors.affiliation: Royal Melbourne Hospital, Melbourne, VIC, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lefkovits
authors.affiliation: Auckland City Hospital, Auckland, New Zealand.
authors.forename: Chris
authors.initials: C
authors.lastname: Ellis
authors.affiliation: SA Health, Adelaide, SA, Australia.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Astley
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Tegwen Eleanor
authors.initials: TE
authors.lastname: Howell
authors.affiliation: University of Otago, Christchurch, New Zealand.
authors.forename: John M
authors.initials: JM
authors.lastname: Elliott
authors.affiliation: Flinders Medical Centre, Adelaide, SA, Australia.
authors.forename: Derek P B
authors.initials: DP
authors.lastname: Chew
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis; D001315:Australia; D015415:Biomarkers / Q000097:blood*; D009520:New Zealand; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D014336:Troponin