title: Use of a high-sensitivity troponin T assay in the assessment and disposition of patients attending a tertiary Australian emergency department: a cross-sectional pilot study.
abstract: OBJECTIVE
  We examined the disposition and outcomes of patients presenting to the ED with symptoms suggestive of acute coronary syndrome undergoing measurement of troponin T using a highly sensitive assay.
  
  
  METHODS
  Troponin T (TnT) was measured in 204 consecutive patients (mean age = 65 [±18] years, 55% men) presenting to the ED with symptoms suggestive of acute coronary syndrome.
  
  
  RESULTS
  Ninety-four patients predominantly had chest pain, 34 had dyspnoea and the remainder had various symptoms. Overall, 96 patients had TnT >14 ng/L (upper reference limit), of whom 31 were admitted to the cardiology service (26 had final cardiac diagnosis [five ST-elevation MI, 10 non-ST-elevation MI, one unstable angina and 10 other cardiac]). Among these 96 patients, 41 had chronic kidney disease, 17 had heart failure and seven had sepsis. At 30 days, death rates among patients who had TnT >14 ng/L with non-cardiac diagnoses and in patients who had TnT >14 ng/L with a cardiac diagnosis were 6.6% and 2.9% (P = 0.652); no death and/or MI occurred in patients with normal TnT levels. At late follow up (median 6.8 months) that was obtained in 189 (93% of 204) patients, four had MI and 14 died (three cardiac deaths).
  
  
  CONCLUSIONS
  Despite high-sensitivity TnT assay having a high sensitivity and specificity for myocardial necrosis, the majority of unselected consecutive patients attending ED in whom TnT levels were elevated did not have an acute coronary syndrome. Our pilot study suggests that a larger study is needed to provide evidence to modify management algorithms.
authors.affiliation: Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia.|South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Yousef Me
authors.initials: YM
authors.lastname: Saad
authors.affiliation: South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.|Department of Emergency, Liverpool Hospital, Sydney, New South Wales, Australia.
authors.forename: James
authors.initials: J
authors.lastname: McEwan
authors.affiliation: Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia.|South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Ibrahim M
authors.initials: IM
authors.lastname: Shugman
authors.affiliation: Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia.|South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Christian
authors.initials: C
authors.lastname: Mussap
authors.affiliation: Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia.|South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Craig P
authors.initials: CP
authors.lastname: Juergens
authors.affiliation: South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.|Department of Emergency, Liverpool Hospital, Sydney, New South Wales, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Ferguson
authors.affiliation: Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia.|South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: John K
authors.initials: JK
authors.lastname: French
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis*; D000368:Aged; D000465:Algorithms; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis; D002637:Chest Pain / Q000097:blood / Q000209:etiology; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000097:blood / Q000209:etiology; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010865:Pilot Projects; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000175:diagnosis; D062606:Tertiary Care Centers; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T
keywords: acute coronary syndrome; chest pain; emergency department; troponin T