Zvi Shimoni1, Rossina Arbuzov2, Paul Froom3. 1. Department of Internal Medicine B, Sanz Medical Center, Laniado Hospital, Netanya, Israel; Ruth and Bruce Rappaport School of Medicine, Haifa, Israel. 2. Department of Internal Medicine B, Sanz Medical Center, Laniado Hospital, Netanya, Israel. 3. Department of Clinical Utility, Sanz Medical Center, Laniado Hospital, Netanya, Israel; School of Public Health, University of Tel Aviv, Israel. Electronic address: froomp@gmail.com.
Abstract
BACKGROUND: Although often recommended by experts, it is unclear if elevated troponin measurements have clinical utility in patients without chest pain or ischemic electrocardiographic changes. OBJECTIVES: The objective of this study was to determine clinical utility, and downstream testing in patients with elevated troponin values but without chest pain or electrocardiographic changes. METHODS: We selected all patients aged 30-100 years hospitalized in cardiology and internal medicine departments from July 1, 2013 until July 31, 2016. We chose a subgroup of 723 consecutive subjects with elevated troponin values for chart review to determine the proportion of patients without chest pain or ischemic electrocardiographic changes, and resultant differential treatment and downstream testing. Clinical utility was defined as coronary artery interventions or treatment of life-threatening arrhythmias. RESULTS: Troponin measurements were sent in 52.5% of all hospitalized patients (16,519/31,448), and were elevated in 29.9% (4938/16,519). Nearly two-thirds of the patients reviewed had neither chest pain nor ischemic electrocardiographic changes (63.3% [458/723]), and the elevated troponin values did not result in coronary artery interventions or treatment of life-threatening arrhythmias. The elevated troponin values were the sole reason for hospitalization in 2.0% (n = 9), for cardiac monitoring in 6.1% (n = 28), for cardiac consultations in 11.1% (n = 51), and for left heart catheterization in 0.7% (n = 3) of the patients. CONCLUSION: Most of the elevated troponin test results were in patients without chest pain or ischemic electrocardiographic changes, had no clinical utility, and resulted in downstream testing.
BACKGROUND: Although often recommended by experts, it is unclear if elevated troponin measurements have clinical utility in patients without chest pain or ischemic electrocardiographic changes. OBJECTIVES: The objective of this study was to determine clinical utility, and downstream testing in patients with elevated troponin values but without chest pain or electrocardiographic changes. METHODS: We selected all patients aged 30-100 years hospitalized in cardiology and internal medicine departments from July 1, 2013 until July 31, 2016. We chose a subgroup of 723 consecutive subjects with elevated troponin values for chart review to determine the proportion of patients without chest pain or ischemic electrocardiographic changes, and resultant differential treatment and downstream testing. Clinical utility was defined as coronary artery interventions or treatment of life-threatening arrhythmias. RESULTS: Troponin measurements were sent in 52.5% of all hospitalized patients (16,519/31,448), and were elevated in 29.9% (4938/16,519). Nearly two-thirds of the patients reviewed had neither chest pain nor ischemic electrocardiographic changes (63.3% [458/723]), and the elevated troponin values did not result in coronary artery interventions or treatment of life-threatening arrhythmias. The elevated troponin values were the sole reason for hospitalization in 2.0% (n = 9), for cardiac monitoring in 6.1% (n = 28), for cardiac consultations in 11.1% (n = 51), and for left heart catheterization in 0.7% (n = 3) of the patients. CONCLUSION: Most of the elevated troponin test results were in patients without chest pain or ischemic electrocardiographic changes, had no clinical utility, and resulted in downstream testing.
Authors: Boyang Tom Jin; Raj Palleti; Siyu Shi; Andrew Y Ng; James V Quinn; Pranav Rajpurkar; David Kim Journal: J Am Med Inform Assoc Date: 2022-10-07 Impact factor: 7.942
Authors: Lane M Smith; Nicklaus P Ashburn; Anna C Snavely; Jason P Stopyra; Kristin M Lenoir; Brian J Wells; Brian C Hiestand; David M Herrington; Chadwick D Miller; Simon A Mahler Journal: Emerg Med J Date: 2020-08-04 Impact factor: 2.740
Authors: Irina Gîrleanu; Anca Trifan; Laura Huiban; Cristina Muzîca; Oana Cristina Petrea; Ana Maria Sîngeap; Camelia Cojocariu; Stefan Chiriac; Tudor Cuciureanu; Irina Iuliana Costache; Carol Stanciu Journal: Life (Basel) Date: 2022-07-12
Authors: Maria M Wertli; Tenzin D Dangma; Sarah E Müller; Laura M Gort; Benjamin S Klauser; Lina Melzer; Ulrike Held; Johann Steurer; Susann Hasler; Jakob M Burgstaller Journal: PLoS One Date: 2019-02-01 Impact factor: 3.240