High-Sensitivity Troponin Test May Cut Mortality Risk

TOPLINE:

Switching from a conventional to a high-sensitivity cardiac troponin I assay in emergency departments is associated with a reduction in both mortality at 1 year and new admissions for myocardial infarction (MI) in patients presenting with suspected acute coronary syndrome.

METHODOLOGY:

• Researchers compared outcomes between hospitals using high-sensitivity cardiac troponin and conventional assays in a retrospective study across nine tertiary hospitals in Australia.
• The analysis included 179,681 patients (mean age, 62 years; 47% women) presenting to the emergency department between March 2011 and November 2015 with suspected acute coronary syndrome who had at least one reported troponin result.
• The study period was divided into a preperiod, during which hospitals used conventional assays (48% patients), and a postperiod, during which they shifted to high-sensitivity assays (52% patients).
• The results for troponin levels were classified as normal or elevated based on the 99th centile report of each laboratory.
• The primary outcome was all-cause death at 1 year; secondary outcomes included all-cause death at 30 days, new MI admissions, and a composite of death/new MI cases at 30 days and 1 year.

TAKEAWAY:

• Switching from conventional to high-sensitivity cardiac troponin I assays in the postperiod was associated with a 10% lower risk for death ( adjusted hazard ratio [aHR], 0.90; 95% CI, 0.85-0.94) and a 12% lower risk for death/new MI (aHR, 0.88; 95% CI, 0.84-0.92) at 1 year.
• Hospitals that did not switch to high-sensitivity assays showed no such reductions in the risk for death.
• The switch to high-sensitivity assays was associated with a 13% reduction in the risk for death (aHR, 0.87; 95% CI, 0.81-0.94) and a 14% reduction in the risk for the composite outcome of death/new MI (aHR, 0.86; 95% CI, 0.79-0.92) at 30 days.
• Switching to high-sensitivity assays was linked to reductions in the risk for new MI admissions at 30 days and 1 year.

IN PRACTICE:

“Our findings support the adoption of high sensitivity troponin testing for patients with suspected ACS [acute coronary syndrome] and emphasise the potential clinical benefits of more sensitive troponin assays,” the authors of the study wrote.

SOURCE:

The study was led by Siobhan Hickling, MPH, of the Cardiovascular Epidemiology Research Centre at the University of Western Australia, in Perth. It was published online on January 16, 2025, in Heart.

LIMITATIONS:

The study had several limitations, including the comparison of data from different time periods and potential risk for residual confounding. Also, follow-up for 72% of the hospitalized patients started at discharge, which led to the exclusion of MIs that occurred at index presentation. Patients at switching sites included a higher proportion of men, had a lower prevalence of cardiac history, and were younger than those at non-switching sites, which may have influenced the observed outcomes.

DISCLOSURES:

The study received funding from the Australian National Health and Medical Research Council and used troponin assays by Abbott. One author received consulting fees from Abbott Vascular, and another received consulting and speaker fees from pharmaceutical and diagnostic companies and served on the advisory and data safety monitoring boards for some of these companies. Some other authors reported financial ties with Siemens Healthineers and Abbott Diagnostics.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.