title: Consequences of high-sensitivity troponin T testing applied in a primary care population with chest pain compared with a commercially available point-of-care troponin T analysis: an observational prospective study.
abstract: BACKGROUND
  There is a demand for a highly sensitive and specific point-of care test to detect acute myocardial infarction (AMI). It is unclear if a high-sensitivity troponin assay will have enough discriminative power to become a decision support in primary care. The aim of this study was to evaluate a high-sensitivity troponin T assay performed in three primary health care centres in southeast Sweden and to compare the outcome with a point-of-care troponin T test.
  
  
  METHODS
  This study included 115 patients who consulted their general practitioner for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue in the last 7 days. Troponin T was analysed by a point-of-care test and a high-sensitivity method together with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and creatinine. All patients were checked for AMI or unstable angina (UA) within 30 days of study enrolment. Univariate and multivariate logistic regression was carried out to examine possible connections between troponin T ≥ 15 ng/L, clinical variables and laboratory findings at baseline. In addition, 21 patients with troponin T ≥ 15 ng/L and no signs of AMI or UA were followed up for 2-3 years.
  
  
  RESULTS
  Three patients were diagnosed with AMI and three with UA. At the ≥ 15 ng/L cut-off, the troponin T method had 100% sensitivity, 75% specificity for AMI and a positive predictive value of 10%. The troponin T point-of-care test missed one case of AMI and the detection limit was 50 ng/L. Troponin T ≥ 15 ng/L was correlated to age ≥65 years (odds ratio (OR), 10.9 95% CI 2.28-51.8) and NT-proBNP in accordance with heart failure (OR 8.62 95% CI 1.61-46.1). Fourteen of the 21 patients, without signs of AMI or UA at baseline, still had increased troponin T at follow-up after 2-3 years.
  
  
  CONCLUSIONS
  A high-sensitivity troponin T assay could become useful in primary care as a point-of-care test for patients <65 years. For patients older than 65-70 years, a higher decision limit than ≥15 ng/L should be considered and used in conjunction with clinical parameters and possibly with NT-proBNP.
authors.affiliation: Primary Health Care and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. per.o.andersson@regionostergotland.se.
authors.forename: Per O
authors.initials: PO
authors.lastname: Andersson
authors.affiliation: Department of Internal Medicine, County Council of Jönköping, Jönköping, Sweden. jan-erik.karlsson@rjl.se.|Department of Medical and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden. jan-erik.karlsson@rjl.se.
authors.forename: Jan-Erik
authors.initials: JE
authors.lastname: Karlsson
authors.affiliation: Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. eva.landberg@regionostergotland.se.
authors.forename: Eva
authors.initials: E
authors.lastname: Landberg
authors.affiliation: Department of Medical and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden. karin.festin@liu.se.
authors.forename: Karin
authors.initials: K
authors.lastname: Festin
authors.affiliation: Primary Health Care and Department of Medical and Health Sciences, Linköping University, Norrköping, Sweden. staffan.g.nilsson@liu.se.
authors.forename: Staffan
authors.initials: S
authors.lastname: Nilsson
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D000067716:Point-of-Care Testing; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013548:Sweden; D013997:Time Factors; D020107:Troponin T / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C545568:TNNT2 protein, human; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D003404:Creatinine