title: Clinical impact of a high-sensitivity troponin assay introduction on patients presenting to the emergency department.
abstract: OBJECTIVE
  Biomarkers are a critical component in the investigation of patients with potential ischaemic heart disease. The proposed benefits of a high-sensitivity troponin (hs-Tn) assay include earlier diagnosis of myocardial infarction. However, the decreased specificity may adversely affect clinical practice. The present study aims to investigate the impact that the introduction of a hs-Tn assay had on patients presenting to the ED.
  
  
  METHODS
  A pre- and post-interventional analysis was performed on all patients presenting to the Royal Melbourne Hospital ED, and had a troponin, in the 12 months before and after the introduction of the hs-Tn assay. The main outcome measures were ED length of stay, admission rates, proportion of patients undergoing interventional cardiac procedures and proportion diagnosed with myocardial infarction.
  
  
  RESULTS
  There were 6557 patients who had a conventional assay and 7335 patients who had a hs-Tn assay. The introduction of a hs-Tn assay was associated with an increased abnormal troponin rate (23.4% vs 28.1%, P < 0.001). The median length of ED stay decreased by 9.1% (P < 0.001). The proportion admitted to hospital increased (60.9% vs 65.9%, P < 0.001); however, there was no difference in the proportion undergoing revascularisation or the proportion diagnosed with myocardial infarction.
  
  
  CONCLUSIONS
  Although the introduction of a hs-Tn assay led to an increase in hospital admissions, the unchanged rate of cardiac procedures or final diagnoses of acute myocardial infarction and ischaemic heart disease suggests that the hs-Tn did not improve the detection of these conditions. It remains unclear whether there was a benefit admitting the additional cohort of patients.
authors.affiliation: Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Peck
authors.affiliation: Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Knott
authors.affiliation: Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lefkovits
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D014336:Troponin
keywords: emergency department; myocardial infarction; myocardial ischaemia; troponin