Trends in admissions for chest pain after the introduction of high-sensitivity cardiac troponin T.
Int J Cardiol. 2017 Aug 01;240:1-7
Authors: Bandstein N, Ljung R, Lundbäck M, Johansson M, Holzmann MJ
BACKGROUND: The aim was to describe temporal trends in admission rates for chest pain and patient outcomes after the clinical introduction of the high-sensitivity cardiac troponin T (hs-cTnT) assay.
METHODS: We included all patients aged >25years presenting with chest pain to the emergency department (ED) at our hospital during 2011-2014. For each year, rates of admissions, coronary angiographies, and revascularizations were determined. After adjustment for confounders, hazard ratios (HR) with 95% confidence intervals (CI) were calculated for mortality or major adverse cardiac events (MACE) within 1year of the ED visit per year, using 2011 as referent.
RESULTS: In total, 15,472 chest pain patients were accountable for 18,237 visits to the ED. The chest pain admission rate in 2011 was 44%; 2012, 39%; 2013, 33%; and 2014, 28%, with an overall decrease in 36%. Coronary angiographies within 1year of the ED visit increased from 6.8% in 2011 to 9.6% in 2013, but the proportion of revascularizations was virtually unchanged. The risk of death within 1year of the visit increased by 51% (HR 1.51, 95% CI, 1.18-1.92) in 2014, compared with 2011. Only non-cardiovascular mortality was significantly increased (HR 1.85, 95% CI, 1.34-2.55), with no increase in MACE.
CONCLUSION: Admissions for chest pain were reduced by 36% the first 4years of hs-cTnT use. We observed no increase in MACE, but all-cause mortality increased significantly for non-cardiovascular causes only which was paralleled by a significant increase in the use of coronary angiographies.
PMID: 28431769 [PubMed - indexed for MEDLINE]