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High-sensitivity troponin test increases diagnosis of MI
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Introduction of a high-sensitivity troponin T test in Sweden led to an increased incidence of MI diagnosis, researchers reported.
The increased reported incidence of MI had no effect on survival but led to increased use of angiography and revascularization and reduced risk for reinfarction, according to the findings published in the Journal of the American College of Cardiology.
“The increase we observed in our study was less than expected, which means that the high-sensitivity troponin test has enabled doctors to single out the patients who benefit from such intervention,” Martin J. Holzmann, MD, PhD, associate professor of epidemiology in the department of medicine at Karolinska Institutet in Solna, Sweden, and physician at Karolinska University Hospital, said in a press release. “We found no differences in medication between the two groups, so the differences in prognosis with fewer new heart attacks could be attributed to the fact that more coronary angiography and balloon dilation procedures have been performed on the right patients.”
Holzmann and colleagues analyzed 87,879 patients in Sweden who had a first MI between 2009 and 2013, of whom 40,746 were diagnosed with the high-sensitivity troponin T test (Elecsys Troponin T Gen 5 STAT, Roche Diagnostics). Those diagnosed with the high-sensitivity test were compared with those diagnosed with other tests.
Outcomes of interest included all-cause mortality, reinfarction, coronary angiographies and revascularizations. Mean follow-up was 3.9 years for all-cause mortality and 3.1 years for reinfarction. Angiography and revascularization outcomes were assessed at 30 days and 90 days.
Diagnosis, outcomes
After the high-sensitivity troponin T test was introduced in Sweden, the incidence of MI diagnosis increased by 5% (95% CI, 0-10), Holzmann and colleagues wrote.
There was no difference between the groups in risk for all-cause mortality (adjusted HR = 1; 95% CI, 0.97-1.02), Holzmann and colleagues wrote.
There were fewer reinfarctions in the high-sensitivity group (aHR = 0.89; 95% CI, 0.86-0.91) but more angiographies (aHR = 1.16; 95% CI, 1.14-1.18) and revascularizations (aHR = 1.13; 95% CI, 1.11-1.15), according to the researchers.
“This surprised us,” Holzmann said in the release. “We didn’t think that the more sensitive test would affect the risk of future heart attacks.”
Impact uncertain
“It is tempting to associate the reduction in reinfarction among patients with MI diagnosed using the [high-sensitivity cardiac troponin] assay with increased use of angiography and revascularization, but this may be too simplistic without more details about the circumstances and timing of use and coronary anatomy,” Cardiology Today Editorial Board Member L. Kristin Newby, MD, MHS, and Angela Lowenstern, MD, both from Duke University Medical Center and Duke Clinical Research Institute, wrote in a related editorial.
“The impact of [high-sensitivity cardiac troponin] assays on clinical care in the United States remains to be fully elucidated,” they wrote. “Implementation will undoubtedly encounter challenges,
but we should embrace the experience emerging from 8 years of use outside of the United States as a solid foundation upon which to build. Adoption (with appropriate modifications) of algorithms for more rapid MI rule-out, resulting in shorter ED stays and decreased costs, will be an immediate benefit.” – by Erik Swain
Disclosures: Holzmann reports he received consultant honoraria from Actelion and Pfizer. Newby reports she received consultancy honoraria from Ortho-Clinical Diagnostics, Philips and Roche Diagnostics. Lowenstern reports no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures.
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