Cardiac troponin is central to the diagnosis of myocardial infarction and high-sensitivity cardiac troponin (hs-cTn) assays are the preferred choice for the assessment of patients with suspected acute coronary syndrome. Since the introduction of hs-cTn assays in Europe in 2010, most hospitals have switched from contemporary sensitive cardiac troponin assays to a hs-cTn assay. The implementation of hs-cTn assays has led to an increase in the number of patients identified with myocardial injury. Although both hs-cTnI and hs-cTnT assays are recommended in current guidelines, the impact of switching from a hs-cTnI assay to a hs-cTnT assay on clinical practice is unknown. At this point, no studies have evaluated the impact of implementing sex-specific hs-cTnT thresholds on the diagnosis of myocardial infarction and outcome in clinical practice. The investigators propose to determine the proportion of patients with and without myocardial injury admitted to the hospital before and after implementation of a hs-cTnT assay and to evaluate the impact on investigations, care and clinical outcomes in consecutive patients with suspected acute coronary syndrome.
Study Type
OBSERVATIONAL
Enrollment
26,000
To investigate the clinical impact on the transition from a hs-cTnI assay to a hs-cTnT assay in consecutive patients presenting to the Emergency Department or Acute Medical Unit with suspected acute coronary syndrome.
Centre for Cardiovascular Science
Edinburgh, United Kingdom
Proportion of patients with suspected acute coronary syndrome admitted to hospital
To determine the proportion of patients with and without myocardial injury admitted to the hospital before and after implementation of the hs-cTnT assay
Time frame: Up to 24 hours
Proportion of patients with myocardial injury admitted to hospital
To determine the proportion of patients with myocardial injury admitted to hospital
Time frame: Up to 24 hours
Length of hospital stay
To determine the length of hospital stay
Time frame: Up to 30 days
Clinical diagnosis of myocardial infarction
To determine the prevalence of myocardial infarction
Time frame: Up to 24 hours
Clinical diagnosis of heart failure
To determine the prevalence of heart failure
Time frame: Up to 24 hours
Coronary angiography during hospital admission
To determine the number of coronary angiograms performed during hospital admission
Time frame: Up to 30 days
Echocardiography during hospital admission
To determine the number of echocardiograms performed during hospital admission
Time frame: Up to 30 days
New prescription of evidence-based treatment for coronary artery disease or heart failure following discharge
To determine the number of new prescriptions of evidence-based treatment for coronary artery disease or heart failure following discharge
Time frame: Up to 30 days
Revascularization at 30 days and one year
To determine the rate of coronary revascularization at 30 days and one year
Time frame: 30 days and 1 year
Reattendance with suspected acute coronary syndrome at 30 days and one year
To determine the rate of reattendance with suspected acute coronary syndrome at 30 days and one year
Time frame: 30 days and 1 year
Subsequent myocardial infarction at 30 days and one year
To determine the prevalence of subsequent myocardial infarction at 30 days and one year
Time frame: 30 days and 1 year
Subsequent heart failure at 30 days and one year
To determine the prevalence of subsequent heart failure at 30 days and one year
Time frame: 30 days and 1 year
Subsequent myocardial infarction, heart failure or cardiovascular death at 30 days and one year
To determine the prevalence of subsequent myocardial infarction, heart failure or cardiovascular death at 30 days and one year
Time frame: 30 days and 1 year
Cardiovascular death at 30 days and one year
To determine the prevalence of cardiovascular death at 30 days and one year
Time frame: 30 days and 1 year
All-cause death at 30 days and one year
To determine the prevalence of all-cause death at 30 days and one year
Time frame: 30 days and 1 year
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