Abstract 13457: High Sensitivity Troponin: Does the 50% Delta Change Alter Clinical Outcomes in Chest Pain Presentations to the Emergency Room?
Background: The National Heart Foundation (NHF) of Australia ACS guidelines recommends the use of high sensitivity troponin assay (hsTrop). Upon introduction of hsTrop assay at Box Hill Hospital (BHH) in February of 2011, 30% Δ was used as the cut off. However, this was changed to 50% Δ 6 months later following an addendum recommendation published in August of 2011.
Aim: Determine the clinical impact of 30 to 50%Δ change for patients presenting with chest pain.
Method: We retrospectively collected data for all patients >18 years presenting with chest or abdominal pain and had hsTrop test between January-June 2012. There were 1804 patients who met the above criteria. 751 (42%) patients who had a STEMI, lacked serial hsTrop values, were on dialysis or had trauma-related chest pain were excluded. All remaining patients were followed up.
Results: Of 1053 patients, 422(40%) with serial hsTrop had at least one abnormal troponin (>14ng/ml). 41 (3.9%) fell within 30-50%Δ. 24 had clinical indications suggestive of ACS and went on to have cardiac investigations and care. Of the remainder, three patients were medically managed for NSTEACS, 14 patients with non-cardiac diagnosis had no further tests. At follow up of these 14 patients, 1 had repeat presentation with unstable angina and was appropriately treated, three died of non cardiac causes, and the remainder had no further cardiac events.
Conclusion: Our data supports the safety of Australian NHF recommendation for change in Δ to 50%.This change affected only 3.9% of the patients and only one patient re-presented with chest pain for investigation. Our clinical decision to investigate 24 of the 41 patients who had Δ<50% underscores the importance of not relying solely on hsTrop assay to rule-out ACS as emphasized in the NHF recommendations.
- © 2013 by American Heart Association, Inc.