Troponin testing yields no clinical value
Elevated troponin test results are mostly present in patients without chest pain or ischaemic electrocardiographic (ECG) changes, have no clinical utility and lead to downstream testing, a recent study has found.
Researchers enrolled patients (aged 30 to 100 years) hospitalized in cardiology and internal medicine departments from 1 July 2013 until 31 July 2016. They selected a subgroup of 723 consecutive patients with elevated troponin values for chart review to determine the proportion of participants without chest pain or ischaemic ECG changes, and resultant differential treatment and downstream testing.
Clinical utility referred to coronary artery interventions or treatment of life-threatening arrhythmias, according to researchers.
Of all hospitalized patients (n=31,448), 52.5 percent (n=16,519) received troponin measurements, and 29.9 percent (n=4,938) of these had elevated troponin values.
About two-thirds of the patients reviewed did not have chest pain or ischaemic ECG changes (63.3 percent). In addition, the elevated troponin values neither resulted in coronary artery interventions nor treatment of life-threatening arrhythmias.
The elevated troponin values were the sole cause of hospitalization in 2.0 percent (n=9), cardiac monitoring in 6.1 percent (n=28), cardiac consultations in 11.1 percent (n=51) and left heart catheterization in 0.7 percent (n=3) of patients.
In an earlier study of patients with chest pain anticipated to have a low prevalence of coronary artery disease (CAD) and a good prognosis, deFilippi and colleagues found that cardiac troponin T identified a subgroup with a high prevalence of extensive and complex CAD and elevated risk for long-term adverse outcomes. [J Am Coll Cardiol 2000;35:1827-34]