title: Impact of high-sensitivity cardiac troponin on use of coronary angiography, cardiac stress testing, and time to discharge in suspected acute myocardial infarction.
abstract: High-sensitivity cardiac troponin (hs-cTn) assays provide higher diagnostic accuracy for acute myocardial infarction (AMI) when compared with conventional assays, but may result in increased use of unnecessary coronary angiographies due to their increased detection of cardiomyocyte injury in conditions other than AMI.
  
  
  
  We evaluated the impact of the clinical introduction of high-sensitivity cardiac troponin T (hs-cTnT) on the use of coronary angiography, stress testing, and time to discharge in 2544 patients presenting with symptoms suggestive of AMI to the emergency department (ED) within a multicentre study either before (1455 patients) or after (1089 patients) hs-cTnT introduction. Acute myocardial infarction was more often the clinical discharge diagnosis after hs-cTnT introduction (10 vs. 14%, P < 0.001), while unstable angina less often the clinical discharge diagnosis (14 vs. 9%, P = 0.007). The rate of coronary angiography was similar before and after the introduction of hs-cTnT (23 vs. 23%, P = 0.092), as was the percentage of coronary angiographies showing no stenosis (11 vs. 7%, P = 0.361). In contrast, the use of stress testing was substantially reduced from 29 to 19% (P < 0.001). In outpatients, median time to discharge from the ED decreased by 79 min (P < 0.001). Mean total costs decreased by 20% in outpatients after the introduction of hs-cTnT (P = 0.002).
  
  
  
  The clinical introduction of hs-cTn does not lead to an increased or inappropriate use of coronary angiography. Introduction of hs-cTn is associated with an improved rule-out process and thereby reduces the need for stress testing and time to discharge.
  
  
  
  www.clinicaltrials.gov. Identifier, NCT00470587.
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.|Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.|Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Cedric
authors.initials: C
authors.lastname: Jaeger
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.|Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Maria
authors.initials: M
authors.lastname: Rubini Gimenez
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.|Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Karin
authors.initials: K
authors.lastname: Wildi
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.|Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.|Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nestelberger
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.|Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Jasper
authors.initials: J
authors.lastname: Boeddinghaus
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.|Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Karin
authors.initials: K
authors.lastname: Grimm
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.|Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Puelacher
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.|Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Berit
authors.initials: B
authors.lastname: Moehring
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.|Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Gil
authors.initials: G
authors.lastname: Pretre
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.|Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Schaerli
authors.affiliation: Servicio de Urgencias y Medicina Interna - Hospital del Mar, Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Campodarve
authors.affiliation: Laboratory Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Katharina
authors.initials: K
authors.lastname: Rentsch
authors.affiliation: Emergency Department, Kantonsspital Luzern, Luzern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Steuer
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.|Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland chmueller@uhbs.ch.|Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D015415:Biomarkers; D017023:Coronary Angiography; D006801:Humans; D009203:Myocardial Infarction; D011446:Prospective Studies; D014336:Troponin
chemical_list: D015415:Biomarkers; D014336:Troponin
keywords: Angiography; Coronary artery disease; High-sensitivity cardiac troponin; Myocardial infarction; Stress testing