Appropriateness of Cardiac Troponin Testing: Insights from the Use of TROPonin In Acute coronary syndromes (UTROPIA) Study

Y. Sandoval, I. L. Gunsolus, Stephen W. Smith, Anne Sexter, Sarah E. Thordsen, Michelle D. Carlson, Benjamin K. Johnson, Charles A. Bruen, Kenneth W. Dodd, Brian E. Driver, Katherine Jacoby, Sara A. Love, Johanna C. Moore, Nathaniel L. Scott, K. Schulz, Fred S. Apple

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: Our objective was to examine the appropriateness of cardiac troponin (cTn) testing among patients with cTn increases. Methods: This is a planned secondary analysis of the Use of TROPonin In Acute coronary syndromes (UTROPIA, NCT02060760) observational cohort study. Appropriateness of cTn testing was adjudicated for emergency department patients with cTn increases > 99th percentile and analyzed using both contemporary and high-sensitivity (hs) cTnI assays according to sub-specialty, diagnoses, and symptoms. Results: Appropriateness was determined from 1272 and 1078 adjudication forms completed for 497 and 422 patients with contemporary and hs-cTnI increases, respectively. Appropriateness of cTnI testing across adjudication forms was 71.5% and 72.0% for cTnI and hs-cTnI, respectively. Compared with emergency physicians, cardiologists were less likely to classify cTnI orders as appropriate (cTnI: 79% vs 56%, P < .0001; hs-cTnI: 82% vs 51%, P < .0001). For contemporary cTnI, appropriateness of 95%, 70%, and 39% was observed among adjudication forms completed by cardiologists for type 1 myocardial infarction, type 2 myocardial infarction, and myocardial injury, respectively; compared with 90%, 86%, and 71%, respectively, among emergency physicians. Similar findings were observed using hs-cTnI. Discordance in appropriateness adjudication forms occurred most frequently in cases of myocardial injury (62% both assays) or type 2 myocardial infarction (cTnI 31%; hs-cTnI 23%). Conclusions: Marked differences exist in the perception of what constitutes appropriate clinical use of cTn testing between cardiologists and emergency physicians, with emergency physicians more likely to see testing as appropriate across a range of clinical scenarios. Discordance derives most often from cases classified as myocardial injury or type 2 myocardial infarction.

Original languageEnglish (US)
Pages (from-to)869-874
Number of pages6
JournalAmerican Journal of Medicine
Volume132
Issue number7
DOIs
StatePublished - Jul 2019

Bibliographical note

Funding Information:
This work was supported partially through (a) a grant from Abbott Diagnostics and (b) the Hennepin Healthcare Research Institute (formerly Minneapolis Medical Research Foundation, MMRF).

Publisher Copyright:
© 2019 Elsevier Inc.

Keywords

  • Appropriate utilization
  • Biomarkers
  • Cardiac troponin
  • Myocardial injury
  • Type 1 myocardial infarction
  • Type 2 myocardial infarction

PubMed: MeSH publication types

  • Journal Article
  • Observational Study
  • Research Support, Non-U.S. Gov't

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