Nadia Bandstein1, Rickard Ljung2, Magnus Lundbäck3, Magnus Johansson4, Martin J Holzmann5. 1. Department of Emergency Medicine, Karolinska University Hospital, Huddinge, Sweden; Department of Internal Medicine, Karolinska Institutet, Solna, Sweden. 2. Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden. 3. Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, and Karolinska Institutet, Stockholm, Sweden. 4. Department of Internal Medicine, Karolinska Institutet, Solna, Sweden. 5. Department of Emergency Medicine, Karolinska University Hospital, Huddinge, Sweden; Department of Internal Medicine, Karolinska Institutet, Solna, Sweden. Electronic address: martin.holzmann@sll.se.
Abstract
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.
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 painpatients 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.
Authors: Jonathan Hinton; Mark Mariathas; Lavinia Gabara; Zoe Nicholas; Rick Allan; Sanjay Ramamoorthy; Mamas A Mamas; Michael Mahmoudi; Paul Cook; Nick Curzen Journal: Clin Med (Lond) Date: 2020-11 Impact factor: 2.659
Authors: Bryn E Mumma; Scott D Casey; Robert K Dang; Michelle K Polen; Jasmanpreet C Kaur; John Rodrigo; Daniel J Tancredi; Robert A Narverud; Ezra A Amsterdam; Nam Tran Journal: Ann Emerg Med Date: 2020-08-15 Impact factor: 5.721
Authors: Kiril M Stoyanov; Hauke Hund; Moritz Biener; Jochen Gandowitz; Christoph Riedle; Julia Löhr; Matthias Mueller-Hennessen; Mehrshad Vafaie; Hugo A Katus; Evangelos Giannitsis Journal: Eur Heart J Acute Cardiovasc Care Date: 2019-07-12