TY - JOUR
T1 - Troponin testing in routine primary care
T2 - observations from a dynamic cohort study in the Amsterdam metropolitan area
AU - Harskamp, Ralf E.
AU - Melessen, Indra M.
AU - Manten, Amy
AU - De Clercq, Lukas
AU - den Elzen, Wendy P.J.
AU - Himmelreich, Jelle C.L.
N1 - Publisher Copyright: © 2024 the author(s), published by De Gruyter.
PY - 2024
Y1 - 2024
N2 - Objectives: Troponin testing is indicated in the diagnostic work-up of acute coronary syndrome (ACS) and incorporated in risk stratification pathways. This study aims to gain insights on the use, outcomes, and diagnostic accuracy of troponin testing in routine primary care; a setting that is understudied. Methods: Routine data were used from the academic primary care network in the Amsterdam metropolitan area (968,433 patient records). The study population included adult patients who underwent high-sensitivity troponin I or T (hsTnI/T) testing between 2011 and 2021. The primary outcome was the reported diagnosis and the secondary outcome was the diagnostic accuracy measured by death or ACS at 30 days. Results: 3,184 patients underwent hs-troponin testing, either with hsTNT (n=2,333) or hsTNI (n=851). Median patients’ age was 55 (44–65) years, and 62.3 % were female. Predominant symptoms were chest pain and dyspnea (56.7 %). Additional diagnostic laboratory tests were commonly performed (CRP: 47.7 %, natriuretic peptides: 25.6 %, d-dimer: 21.5 %). Most common diagnoses were musculoskeletal symptoms (21.6 %) and coronary heart disease (7.1 %; 1.1 % ACS). Troponin testing showed sensitivity and specificity of 77.8 % (60.9–89.9) and 94.3 % (93.5–95.1), respectively. Negative and positive predictive values were 99.7 (99.5–99.9) and 13.5 (11.1–16.4), and positive and negative likelihood ratios were 13.7 (10.9–17.1) and 0.24 (0.13–0.43). Conclusions: GPs occasionally use troponin testing in very low-risk patients, often as part of a multi-marker rule-out strategy. The diagnostic characteristics of troponin tests, while promising, warrant prospective validation and implementation to facilitate appropriate use.
AB - Objectives: Troponin testing is indicated in the diagnostic work-up of acute coronary syndrome (ACS) and incorporated in risk stratification pathways. This study aims to gain insights on the use, outcomes, and diagnostic accuracy of troponin testing in routine primary care; a setting that is understudied. Methods: Routine data were used from the academic primary care network in the Amsterdam metropolitan area (968,433 patient records). The study population included adult patients who underwent high-sensitivity troponin I or T (hsTnI/T) testing between 2011 and 2021. The primary outcome was the reported diagnosis and the secondary outcome was the diagnostic accuracy measured by death or ACS at 30 days. Results: 3,184 patients underwent hs-troponin testing, either with hsTNT (n=2,333) or hsTNI (n=851). Median patients’ age was 55 (44–65) years, and 62.3 % were female. Predominant symptoms were chest pain and dyspnea (56.7 %). Additional diagnostic laboratory tests were commonly performed (CRP: 47.7 %, natriuretic peptides: 25.6 %, d-dimer: 21.5 %). Most common diagnoses were musculoskeletal symptoms (21.6 %) and coronary heart disease (7.1 %; 1.1 % ACS). Troponin testing showed sensitivity and specificity of 77.8 % (60.9–89.9) and 94.3 % (93.5–95.1), respectively. Negative and positive predictive values were 99.7 (99.5–99.9) and 13.5 (11.1–16.4), and positive and negative likelihood ratios were 13.7 (10.9–17.1) and 0.24 (0.13–0.43). Conclusions: GPs occasionally use troponin testing in very low-risk patients, often as part of a multi-marker rule-out strategy. The diagnostic characteristics of troponin tests, while promising, warrant prospective validation and implementation to facilitate appropriate use.
KW - accuracy
KW - acute symptoms
KW - diagnostic use
KW - primary care
KW - troponin
UR - http://www.scopus.com/inward/record.url?scp=85183908473&partnerID=8YFLogxK
U2 - 10.1515/dx-2023-0183
DO - 10.1515/dx-2023-0183
M3 - Article
C2 - 38281102
SN - 2194-8011
JO - Diagnosis
JF - Diagnosis
ER -