Did the introduction of high-sensitivity Troponin T for the assessment of suspected acute coronary syndrome in Malta result in reduction of hospitalization time? A retrospective review

Abstract

Aims: Troponins I and T are biomarkers used for diagnosing myocardial infarction. The recently developed high-sensitivity Troponin T assay can detect levels as low as 3 ng/L which gives the advantage of rapid diagnosis of acute coronary syndrome (ACS) allowing earlier intervention and theoretically earlier discharge. The aim of the study was to audit the hospital practice and its adherence to international guidelines in using Troponin for diagnosing ACS, and to assess the average hospital admission length when using Troponin T compared to the older Troponin I.

Methodology: A retrospective study that included all patients who had Troponin T taken between January 1st and January 31st, 2016 at Mater Dei Hospital (MDH), comparing them to patients who had Troponin I taken between November 1st and November 30th, 2015.

Results: Data collection yielded a total of 1,032 patients in the Troponin T group and 1,004 patients in the Troponin I group. The average length of stay when using Troponin T was 5.53 days whereas the average length of stay when using Troponin I was 8.29 days. Data analysis of those patients also showed that the average time interval between the first and second Troponin was in the region of 9 hours, which is not what the current guidelines recommend.

Conclusion: The use of the new highly sensitive Troponin T resulted in an average reduction in hospitalization time of 2.76 days per patient at MDH. Adherence to the “0/3 hours” guideline of the second Troponin is highly recommended.