High-Sensitivity Troponin Test Could Identify Low-Risk Chest Pain Patients in the ED

March 30th, 2014

High-Sensitivity Troponin Test Could Identify Low-Risk Chest Pain Patients in the ED

Larry Husten, PHD

Approximately 15-20 million people in Europe and the United States go to the emergency department every year with chest pain. Many can be discharged early if they are not having an acute coronary syndrome. A large, new, single-center observational study, presented at the American College of Cardiology meeting in Washington, DC and published simultaneously in the Journal of the American College of Cardiology, provides fresh evidence that high-sensitivity cardiac troponin T (hs-cTnT) may be useful in helping identify chest pain patients in the emergency department who do not need to be admitted to the hospital.

Nadia Bandstein reported on 14,636 patients who presented to the emergency department at a Swedish hospital and had a hs-cTnT test. Of these, 61% (8,907) had a hs-cTnT below 5 ng/l. At 30 days, only 0.44% (39) of these patients had an MI. None of the patients in this group died. A total of 15 had MIs with no ischemic ECG changes. The authors calculated a negative predictive value of 99.8%.

The rapid and accurate diagnosis of MI in chest pain patients has been long sought and elusive. Bandstein said that in her hospital chest pain is “the second most common symptom reported in the emergency department. Since there are no established ways to quickly rule out heart attack, many patients are admitted to the hospital unnecessarily, at a large cost to the patient and to society.”

“Despite our observations before the study, we were still surprised by the strength of our findings,” Bandstein said in a press release. “Using this blood test along with an ECG, we will save about 500 to 1,000 admissions per year in our hospital alone, allowing us to use the beds for sicker patients.”

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March 30th, 2014