Coronary disease & ACSSecondary analysis
Implementation of a high sensitivity cardiac troponin I assay and risk of myocardial infarction or death at five years: observational analysis of a stepped wedge, cluster randomised controlled trial
- Secondary observational analysis of a stepped wedge, cluster randomised controlled trial
- 10 centres in Scotland, UK
Authors' conclusion
Implementation of a high sensitivity cardiac troponin I assay in the assessment of patients with suspected acute coronary syndrome was associated with a reduced risk of subsequent myocardial infarction or death at five years in those reclassified by the high sensitivity assay. Improvements in outcome were greatest in patients with non-ischaemic myocardial injury, suggesting a broader benefit beyond the identification of myocardial infarction.
Study context
- Population
- Consecutive patients with suspected ACS at secondary and tertiary care centres in Scotland, UK
- Participants
- 48,282 patients · 10 hospitals
- Comparison
- After implementation vs Before implementation
- After implementationn = 29,304
- Before implementationn = 18,978reference
- Primary endpoint
- MI or death
- Follow-up
- Five years
Primary result
MI or death, all patients
Adjusted hazard ratio
0.97
95% CI 0.93–1.01
Events by treatment group
After implementation vs Before implementation
adjusted HR 0.97 (95% CI 0.93–1.01)
As reported in the abstract
Further findings
| Outcome | After implementation | Before implementation | Estimate | |
|---|---|---|---|---|
| MI or death, patients reclassified by the high sensitivity assay (subgroup) · five years | 53.9% | 63.0% | adjusted HR 0.82 (95% CI 0.72–0.94) | |
| MI or death, by diagnosis (subgroup) · non-ischaemic myocardial injury | HR 0.83 (CI 0.75–0.91) | |||
| MI or death, by diagnosis (subgroup) · type 1 MI | HR 0.92 (CI 0.83–1.01) | |||
| MI or death, by diagnosis (subgroup) · type 2 MI | HR 0.98 (CI 0.84–1.14) | |||
| 0.512Ratio (log scale) |
- MI or death, patients reclassified by the high sensitivity assay (subgroup): 1771 (17.1%) of 10 360 with troponin >99th centile reclassified
Original publication
Implementation of a high sensitivity cardiac troponin I assay and risk of myocardial infarction or death at five years: observational analysis of a stepped wedge, cluster randomised controlled trial. BMJ. Published 27 November 2023. doi:10.1136/bmj-2023-075009
Summarised from the published abstract; every number is checked against it