Evidence map›Paper›PMID 28695975›Full record

ArticleCardiology journal2017

Decreased admissions and hospital costs with a neutral effect on mortality following lowering of the troponin T cutoff point to the 99th percentile.

Christian Bjurman, Matteus Zywczyk, Bertil Lindahl, Tobias Carlsson, Per Johanson, Max Petzold, Martin Holzmann, Michael Lx Fu, Ola Hammarsten

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Cardiology journal, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Christian Bjurman
Matteus Zywczyk
Bertil Lindahl
Tobias Carlsson
Per Johanson
Max Petzold
Martin Holzmann
Michael Lx Fu
Ola HammarstenOla Hammarsten, MD, PhD, Professor Senior Physician Conjoint Professor, Newcastle University, Australia Institution of Biochemistry Department of clinical chemistry and transfusion medicine Bruna straket 16 Sahlgrenska academy at the University of Gothenburg SE 413 45 Gothenburg Sweden Email: ola.hammarsten@clinchem.gu.se Phone Lab:+46-31-342 9941 Mobile: +46-733-200834 Fax:+46-31-82 84 58. ola.hammarsten@clinchem.gu.se.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe implementation of high-sensitivity cardiac troponin T (hs-cTnT) assays and a cutoff based on the 99th cTnT percentile in the evaluation of patients with suspected acute coronary syndrome has not been uniform due to uncertain effects on health benefits and utilization of limited resources.

methodsClinical and laboratory data from patients with chest pain or dyspnea at the emergency de¬partment (ED) were evaluated before (n = 20516) and after (n = 18485) the lowering of the hs-cTnT cutoff point from 40 ng/L to the 99th hs-cTnT percentile of 14 ng/L in February 2012. Myocardial infarction (MI) was diagnosed at the discretion of the attending clinicians responsible for the patient.

resultsFollowing lowering of the hs-cTnT cutoff point fewer ED patients with chest pain or dyspnea as the principal complaint were analyzed with an hs-cTnT sample (81% vs. 72%, p < 0.001). Overall 30-day mortality was unaffected but increased among patients not analyzed with an hs-cTnT sample (5.3% vs. 7.6%, p < 0.001). The MI frequency was unchanged (4.0% vs. 3.9%, p = 0.72) whereas admission rates decreased (51% vs. 45%, p < 0.001) as well as hospital costs. Coronary angiographies were used more frequently (2.8% vs. 3.3%, p = 0.004) but with no corresponding change in coronary interventions.

conclusionsAt the participating hospital, lowering of the hs-cTnT cutoff point to the 99th percentile decreased admissions and hospital costs but did not result in any apparent prognostic or treatment benefits for the patients.

Indexed as

Acute Coronary SyndromeAgedAged, 80 and overBiomarkersElectrocardiographyEmergency Service, HospitalFemaleFollow-Up StudiesHospital CostsHospital MortalityHumansMaleMiddle AgedPatient AdmissionPredictive Value of TestsRetrospective StudiesBiomarkersTroponin T99th percentilehigh-sensitivity troponin Thospital admissionshs-cTnTmortality

Identifiers

PMID28695975

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.