title: Randomized Comparison of High-Sensitivity Troponin Reporting in Undifferentiated Chest Pain Assessment.
abstract: High-sensitivity troponin T (hs-TnT) assays promise greater discrimination of evolving myocardial infarction, but the impact of unguided implementation on the effectiveness of care is uncertain.
  
  
  
  We evaluated the impact of hs-TnT reporting on care and outcome among chest pain patients presenting to 5 emergency departments within a multicenter randomized trial. Patients were allocated to hs-TnT reporting (hs-report) or standard reporting (std-report; Roche Elecys). The primary end point was death and new or recurrent acute coronary syndrome by 12 months. A total of 1937 patients without ST-segment elevation were enrolled between July 2011 and March 2013. The median age was 61 (interquartile range, 48-74) years, and 46.3% were women. During the index hospitalization, 1466 patients (75.7%) had maximal troponin <30 ng/L within 24 hours. Randomization to hs-report format did not alter the admission rate (hs-report: 57.7% versus std-report: 58.0%; P=0.069). There was no difference in angiography (hs-report: 11.9% versus std-report: 10.9%; P=0.479). The hs-reporting did not reduce 12-month death or new/recurrent acute coronary syndrome in the overall population (hs-report: 9.7% versus std-report: 7.2% [hazard ratio, 0.83 (0.57-1.22); P=0.362]). However, among those with troponin levels <30 ng/L, a modest reduction in the primary end point was observed (hs-report: 2.6% versus std-report: 4.4%, [hazard ratio, 0.58; 95% confidence interval, 0.34-0.1.00; P=0.050).
  
  
  
  High-sensitivity troponin reporting alone is associated with only modest changes in practice. Clinical effectiveness in the adoption of high-sensitivity troponin may require close coupling with protocols that guide interpretation and care.
  
  
  
  URL: http://www.ANZCTR.org.au. Unique identifier: ACTRN12611000879965.
authors: From the Flinders University, Adelaide, South Australia, Australia (D.P.C., H.G., C.A., S.Q., J.R., P.G.A.); Flinders Medical Centre, Adelaide, South Australia, Australia (D.P.C., P.G.A.); University of Adelaide, Adelaide, South Australia, Australia (C.Z., M.W., J.B.); The Royal Adelaide Hospital, Adelaide, South Australia, Australia (C.Z., M.W.); The Queen Elizabeth Hospital, Adelaide South Australia, Australia (J.B.); The Lyell McEwen Hospital, Adelaide, South Australia, Australia (M.A.); SA Pathology, SA Health Adelaide, South Australia, Australia (P.C.); Heart Foundation, South Australia, Australia (C.A.); and SA Health, Adelaide, Australia (M.H.). derek.chew@flinders.edu.au.
authors: Derek P
authors: DP
authors: Chew
authors: From the Flinders University, Adelaide, South Australia, Australia (D.P.C., H.G., C.A., S.Q., J.R., P.G.A.); Flinders Medical Centre, Adelaide, South Australia, Australia (D.P.C., P.G.A.); University of Adelaide, Adelaide, South Australia, Australia (C.Z., M.W., J.B.); The Royal Adelaide Hospital, Adelaide, South Australia, Australia (C.Z., M.W.); The Queen Elizabeth Hospital, Adelaide South Australia, Australia (J.B.); The Lyell McEwen Hospital, Adelaide, South Australia, Australia (M.A.); SA Pathology, SA Health Adelaide, South Australia, Australia (P.C.); Heart Foundation, South Australia, Australia (C.A.); and SA Health, Adelaide, Australia (M.H.).
authors: Christopher
authors: C
authors: Zeitz
authors: From the Flinders University, Adelaide, South Australia, Australia (D.P.C., H.G., C.A., S.Q., J.R., P.G.A.); Flinders Medical Centre, Adelaide, South Australia, Australia (D.P.C., P.G.A.); University of Adelaide, Adelaide, South Australia, Australia (C.Z., M.W., J.B.); The Royal Adelaide Hospital, Adelaide, South Australia, Australia (C.Z., M.W.); The Queen Elizabeth Hospital, Adelaide South Australia, Australia (J.B.); The Lyell McEwen Hospital, Adelaide, South Australia, Australia (M.A.); SA Pathology, SA Health Adelaide, South Australia, Australia (P.C.); Heart Foundation, South Australia, Australia (C.A.); and SA Health, Adelaide, Australia (M.H.).
authors: Matthew
authors: M
authors: Worthley
authors: From the Flinders University, Adelaide, South Australia, Australia (D.P.C., H.G., C.A., S.Q., J.R., P.G.A.); Flinders Medical Centre, Adelaide, South Australia, Australia (D.P.C., P.G.A.); University of Adelaide, Adelaide, South Australia, Australia (C.Z., M.W., J.B.); The Royal Adelaide Hospital, Adelaide, South Australia, Australia (C.Z., M.W.); The Queen Elizabeth Hospital, Adelaide South Australia, Australia (J.B.); The Lyell McEwen Hospital, Adelaide, South Australia, Australia (M.A.); SA Pathology, SA Health Adelaide, South Australia, Australia (P.C.); Heart Foundation, South Australia, Australia (C.A.); and SA Health, Adelaide, Australia (M.H.).
authors: Hugh
authors: H
authors: Grantham
authors: From the Flinders University, Adelaide, South Australia, Australia (D.P.C., H.G., C.A., S.Q., J.R., P.G.A.); Flinders Medical Centre, Adelaide, South Australia, Australia (D.P.C., P.G.A.); University of Adelaide, Adelaide, South Australia, Australia (C.Z., M.W., J.B.); The Royal Adelaide Hospital, Adelaide, South Australia, Australia (C.Z., M.W.); The Queen Elizabeth Hospital, Adelaide South Australia, Australia (J.B.); The Lyell McEwen Hospital, Adelaide, South Australia, Australia (M.A.); SA Pathology, SA Health Adelaide, South Australia, Australia (P.C.); Heart Foundation, South Australia, Australia (C.A.); and SA Health, Adelaide, Australia (M.H.).
authors: John
authors: J
authors: Beltrame
authors: From the Flinders University, Adelaide, South Australia, Australia (D.P.C., H.G., C.A., S.Q., J.R., P.G.A.); Flinders Medical Centre, Adelaide, South Australia, Australia (D.P.C., P.G.A.); University of Adelaide, Adelaide, South Australia, Australia (C.Z., M.W., J.B.); The Royal Adelaide Hospital, Adelaide, South Australia, Australia (C.Z., M.W.); The Queen Elizabeth Hospital, Adelaide South Australia, Australia (J.B.); The Lyell McEwen Hospital, Adelaide, South Australia, Australia (M.A.); SA Pathology, SA Health Adelaide, South Australia, Australia (P.C.); Heart Foundation, South Australia, Australia (C.A.); and SA Health, Adelaide, Australia (M.H.).
authors: Margaret
authors: M
authors: Arstall
authors: From the Flinders University, Adelaide, South Australia, Australia (D.P.C., H.G., C.A., S.Q., J.R., P.G.A.); Flinders Medical Centre, Adelaide, South Australia, Australia (D.P.C., P.G.A.); University of Adelaide, Adelaide, South Australia, Australia (C.Z., M.W., J.B.); The Royal Adelaide Hospital, Adelaide, South Australia, Australia (C.Z., M.W.); The Queen Elizabeth Hospital, Adelaide South Australia, Australia (J.B.); The Lyell McEwen Hospital, Adelaide, South Australia, Australia (M.A.); SA Pathology, SA Health Adelaide, South Australia, Australia (P.C.); Heart Foundation, South Australia, Australia (C.A.); and SA Health, Adelaide, Australia (M.H.).
authors: Penelope
authors: P
authors: Coates
authors: From the Flinders University, Adelaide, South Australia, Australia (D.P.C., H.G., C.A., S.Q., J.R., P.G.A.); Flinders Medical Centre, Adelaide, South Australia, Australia (D.P.C., P.G.A.); University of Adelaide, Adelaide, South Australia, Australia (C.Z., M.W., J.B.); The Royal Adelaide Hospital, Adelaide, South Australia, Australia (C.Z., M.W.); The Queen Elizabeth Hospital, Adelaide South Australia, Australia (J.B.); The Lyell McEwen Hospital, Adelaide, South Australia, Australia (M.A.); SA Pathology, SA Health Adelaide, South Australia, Australia (P.C.); Heart Foundation, South Australia, Australia (C.A.); and SA Health, Adelaide, Australia (M.H.).
authors: Carolyn
authors: C
authors: Astley
authors: From the Flinders University, Adelaide, South Australia, Australia (D.P.C., H.G., C.A., S.Q., J.R., P.G.A.); Flinders Medical Centre, Adelaide, South Australia, Australia (D.P.C., P.G.A.); University of Adelaide, Adelaide, South Australia, Australia (C.Z., M.W., J.B.); The Royal Adelaide Hospital, Adelaide, South Australia, Australia (C.Z., M.W.); The Queen Elizabeth Hospital, Adelaide South Australia, Australia (J.B.); The Lyell McEwen Hospital, Adelaide, South Australia, Australia (M.A.); SA Pathology, SA Health Adelaide, South Australia, Australia (P.C.); Heart Foundation, South Australia, Australia (C.A.); and SA Health, Adelaide, Australia (M.H.).
authors: Stephen
authors: S
authors: Quinn
authors: From the Flinders University, Adelaide, South Australia, Australia (D.P.C., H.G., C.A., S.Q., J.R., P.G.A.); Flinders Medical Centre, Adelaide, South Australia, Australia (D.P.C., P.G.A.); University of Adelaide, Adelaide, South Australia, Australia (C.Z., M.W., J.B.); The Royal Adelaide Hospital, Adelaide, South Australia, Australia (C.Z., M.W.); The Queen Elizabeth Hospital, Adelaide South Australia, Australia (J.B.); The Lyell McEwen Hospital, Adelaide, South Australia, Australia (M.A.); SA Pathology, SA Health Adelaide, South Australia, Australia (P.C.); Heart Foundation, South Australia, Australia (C.A.); and SA Health, Adelaide, Australia (M.H.).
authors: Julie
authors: J
authors: Ratcliffe
authors: From the Flinders University, Adelaide, South Australia, Australia (D.P.C., H.G., C.A., S.Q., J.R., P.G.A.); Flinders Medical Centre, Adelaide, South Australia, Australia (D.P.C., P.G.A.); University of Adelaide, Adelaide, South Australia, Australia (C.Z., M.W., J.B.); The Royal Adelaide Hospital, Adelaide, South Australia, Australia (C.Z., M.W.); The Queen Elizabeth Hospital, Adelaide South Australia, Australia (J.B.); The Lyell McEwen Hospital, Adelaide, South Australia, Australia (M.A.); SA Pathology, SA Health Adelaide, South Australia, Australia (P.C.); Heart Foundation, South Australia, Australia (C.A.); and SA Health, Adelaide, Australia (M.H.).
authors: Matthew
authors: M
authors: Horsfall
authors: From the Flinders University, Adelaide, South Australia, Australia (D.P.C., H.G., C.A., S.Q., J.R., P.G.A.); Flinders Medical Centre, Adelaide, South Australia, Australia (D.P.C., P.G.A.); University of Adelaide, Adelaide, South Australia, Australia (C.Z., M.W., J.B.); The Royal Adelaide Hospital, Adelaide, South Australia, Australia (C.Z., M.W.); The Queen Elizabeth Hospital, Adelaide South Australia, Australia (J.B.); The Lyell McEwen Hospital, Adelaide, South Australia, Australia (M.A.); SA Pathology, SA Health Adelaide, South Australia, Australia (P.C.); Heart Foundation, South Australia, Australia (C.A.); and SA Health, Adelaide, Australia (M.H.).
authors: Philip G
authors: PG
authors: Aylward
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: acute coronary syndrome; angiography; clinical trial; myocardial infarction; troponin T