First survey on the use of cardiac troponins in chest pain in Rosario city, Argentina

Abstract

Objectives:To survey aspects related to the use of cardiac troponins (cTn) in the context of chest pain (CP) in the city of Rosario. We determined the situations in which they were put into practice, the auxiliary methods used and their results, and the hospital events with their diagnostic
prediction.Materials and methods: Cross-sectional cohort, multicenter design, local in scope (Rosario city).Consultations for CP were included when at least one cTn measurement had been requested in order to rule out acute coronary syndrome.The baseline characteristics, aspects related to the request for cTn and other auxiliary tests, and the in-hospital prognosis were analyzed.
Results:There were 734 individuals, 62% (n=456) male. The average age was 57 years (47-65);79% (n=581) did not have alterations in electrocardiogram and 83% (n=608) had some algorithm followed for their evaluation.Most were evaluated only in the emergency room (61%- n=446) and
the cTn T reagent was the one most widely used (82%- n=603).In 34% (n=249) a first measurementabove the 99th percentile (99p) was obtained.In this group, more auxiliary tests were performed (77% vs 31%; p<0.001); a higher prevalence of significant coronary lesions was found (50% vs 6%;p<0.001) and they showed higher rates of in-hospital mortality (4% vs 0%; p<0.001) and of the composite event of death and revascularization (50% vs 5%; p<0.001).The negative predictive value for composite events was 95% and for mortality 100%.Conclusions: One third of the population showed cTn higher than 99p; a group that underwent more auxiliary tests and with a higher prevalence of obstructive coronary disease and in-hospital events.