Projects per year
Abstract
Abstract
Objective: To evaluate the impact of implementing a high-sensitivity cardiac troponin I assay on long-term outcomes in patients with suspected acute coronary syndrome
Design: Secondary observational analysis of a stepped-wedge cluster-randomised controlled trial.
Setting: Ten secondary and tertiary care centres
Participants: Consecutive patients with suspected acute coronary syndrome (n=48,282; 47% women) were included in this trial. Myocardial injury was defined as any high-sensitivity cardiac troponin I concentration >99th centile of 16 ng/L in women and 34 ng/L in men.
Intervention: Hospital sites were randomly allocated to early (n=5 hospitals) or late (n=5 hospitals) implementation of a high-sensitivity cardiac troponin I assay with sex-specific diagnostic thresholds.
Main Outcome Measures: Subsequent myocardial infarction or death at 5 years.
Results: Overall, 10,360 patients had cardiac troponin concentrations greater than the 99th centile of whom 1,771 (17%) were reclassified by the high-sensitivity assay. The 5-year incidence of subsequent myocardial infarction or death before and after implementation of the high-sensitivity assay was 29% (5,588/18,978) versus 26% (7,591/29,304), respectively, in all patients (adjusted hazard ratio [aHR] 0.97 [95% CI 0.93 to 1.01]), and 63% (456/720) versus 54% (567/1,051) in those reclassified by the high-sensitivity assay (aHR 0.82 [0.72-0.94]). Following implementation, a reduction in subsequent myocardial infarction or death was observed in patients with non-ischemic myocardial injury (aHR 0·83 [0·75-0·91]), but not in those with type 1 or type 2 myocardial infarction (aHR 0·92 [0·83-1·01] and 0·98 [0·84-1·14]).
Conclusions: In patients with suspected acute coronary syndrome, implementation of a high-sensitivity cardiac troponin assay reduced the risk of subsequent myocardial infarction or death at 5 years in those reclassified by the high-sensitivity assay. Improvements in outcome were greatest in patients with non-ischemic myocardial injury suggesting a broader benefit beyond the identification of myocardial infarction.
Objective: To evaluate the impact of implementing a high-sensitivity cardiac troponin I assay on long-term outcomes in patients with suspected acute coronary syndrome
Design: Secondary observational analysis of a stepped-wedge cluster-randomised controlled trial.
Setting: Ten secondary and tertiary care centres
Participants: Consecutive patients with suspected acute coronary syndrome (n=48,282; 47% women) were included in this trial. Myocardial injury was defined as any high-sensitivity cardiac troponin I concentration >99th centile of 16 ng/L in women and 34 ng/L in men.
Intervention: Hospital sites were randomly allocated to early (n=5 hospitals) or late (n=5 hospitals) implementation of a high-sensitivity cardiac troponin I assay with sex-specific diagnostic thresholds.
Main Outcome Measures: Subsequent myocardial infarction or death at 5 years.
Results: Overall, 10,360 patients had cardiac troponin concentrations greater than the 99th centile of whom 1,771 (17%) were reclassified by the high-sensitivity assay. The 5-year incidence of subsequent myocardial infarction or death before and after implementation of the high-sensitivity assay was 29% (5,588/18,978) versus 26% (7,591/29,304), respectively, in all patients (adjusted hazard ratio [aHR] 0.97 [95% CI 0.93 to 1.01]), and 63% (456/720) versus 54% (567/1,051) in those reclassified by the high-sensitivity assay (aHR 0.82 [0.72-0.94]). Following implementation, a reduction in subsequent myocardial infarction or death was observed in patients with non-ischemic myocardial injury (aHR 0·83 [0·75-0·91]), but not in those with type 1 or type 2 myocardial infarction (aHR 0·92 [0·83-1·01] and 0·98 [0·84-1·14]).
Conclusions: In patients with suspected acute coronary syndrome, implementation of a high-sensitivity cardiac troponin assay reduced the risk of subsequent myocardial infarction or death at 5 years in those reclassified by the high-sensitivity assay. Improvements in outcome were greatest in patients with non-ischemic myocardial injury suggesting a broader benefit beyond the identification of myocardial infarction.
| Original language | English |
|---|---|
| Journal | The BMJ |
| Publication status | Published - 27 Nov 2023 |
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High-Sensitivity Cardiac Troponin Beyond the Acute Coronary Syndrome
Mills, N. (Principal Investigator), Anand, A. (Co-investigator), Chapman, A. (Co-investigator), Ferry, A. (Co-investigator), Newby, D. (Co-investigator), Strachan, F. (Co-investigator) & Tsanas, T. (Co-investigator)
1/06/20 → 31/05/25
Project: Research
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Dissecting activation, heterogeneity and crosstalk of PDGFRa/b+ cells in valvular stenosis and left ventricular remodelling following aortic stenosis
Henderson, N. (Principal Investigator)
1/09/19 → 1/10/22
Project: Research
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High-sensitivity Cardiac Troponin I and Risk Stratification of Patients with Suspected Acute Coronary Syndrome
Mills, N. (Principal Investigator) & Lee, K. (Co-investigator)
26/03/18 → 3/08/21
Project: Research
Equipment
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British Heart Foundation (BHF) Cardiovascular Biomarker Laboratory
Fujisawa, T. (Manager)
Deanery of Clinical SciencesFacility/equipment: Facility