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Stratified reporting of high sensitivity troponin I assay is associated with suboptimal management of patients with acute coronary syndrome and intermediate troponin elevation.
MedLine Citation:
PMID:  24038227     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Newer troponin assays provide high sensitivity and precision and are reported in a stratified manner by some laboratories. We sought to investigate the clinical impact of such reporting in the treatment of patients with suspected acute coronary syndrome (ACS).
METHODS: We identified patients presenting with suspected ACS over a one-year period. Patients were stratified based on their peak troponin I values within 24 hours of admission into the following categories as reported by our laboratory: troponin value ≤0.03 ng/ml, which is reported as normal (negative troponin group), troponin value 0.04-0.29 ng/ml, which is reported as suggestive of myocardial damage (intermediate troponin group), and troponin value ≥0.3 ng/ml which is reported as indicative of myocardial necrosis (high troponin group).
RESULTS: Plasma troponin concentrations were ≤0.03 ng/ml in 77 patients (68.7%), 0.04-0.29 ng/ml in 18 patients (16.1%), and ≥0.30 ng/ml in 17 patients (15.2%). Patients in the intermediate troponin group had thrombolysis in myocardial infarction (TIMI) risk scores that were similar to that of the high troponin group. Despite this, patients in the intermediate troponin group were almost 50% less likely to receive coronary angiography, anticoagulation, and clopidogrel when compared to the high troponin group.
CONCLUSION: Patients in the intermediate troponin group that meet the guideline definition of acute myocardial infarction are less likely to receive optimal medical and invasive therapy as compared to the high troponin group even though TIMI risk scores were similar in the two groups.
Authors:
Jiwon Kim; Sainath Gaddam; Wen-Chih Wu; Vikram Behera; Satish Sharma; Gaurav Choudhary
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of clinical laboratory analysis     Volume:  27     ISSN:  1098-2825     ISO Abbreviation:  J. Clin. Lab. Anal.     Publication Date:  2013 Sep 
Date Detail:
Created Date:  2013-09-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8801384     Medline TA:  J Clin Lab Anal     Country:  United States    
Other Details:
Languages:  eng     Pagination:  402-6     Citation Subset:  IM    
Copyright Information:
© 2013 Wiley Periodicals, Inc.
Affiliation:
Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
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