Switching From Cardiac Troponin I to T (TWITCH-ED)

University of Edinburgh

Status: Completed

Conditions: Acute Coronary Syndrome; Chest Pain; Heart Failure; Acute Myocardial Ischemia; Acute Myocardial Infarction; Myocardial Injury

Treatments: Diagnostic Test: Clinical implementation of hs-cTnT

Study type: Observational

Funder types: Other

Identifiers

NCT05748691

DL-2022-046

Details and patient eligibility

About

Cardiac troponin is central to the diagnosis of myocardial infarction and high-sensitivity cardiac troponin (hs-cTn) assays are the preferred choice for the assessment of patients with suspected acute coronary syndrome.

Since the introduction of hs-cTn assays in Europe in 2010, most hospitals have switched from contemporary sensitive cardiac troponin assays to a hs-cTn assay. The implementation of hs-cTn assays has led to an increase in the number of patients identified with myocardial injury. Although both hs-cTnI and hs-cTnT assays are recommended in current guidelines, the impact of switching from a hs-cTnI assay to a hs-cTnT assay on clinical practice is unknown. At this point, no studies have evaluated the impact of implementing sex-specific hs-cTnT thresholds on the diagnosis of myocardial infarction and outcome in clinical practice.

The investigators propose to determine the proportion of patients with and without myocardial injury admitted to the hospital before and after implementation of a hs-cTnT assay and to evaluate the impact on investigations, care and clinical outcomes in consecutive patients with suspected acute coronary syndrome.

Enrollment: 26,000 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 18 years and over
• Symptoms of possible acute coronary syndrome
• High-sensitivity cardiac troponin measured at presentation

Exclusion criteria

• Insufficient clinical information to perform record linkage
• Previous enrolment in the study
• Patients with ST-segment elevation myocardial infarction (STEMI)

Trial design

26,000 participants in 2 patient groups

Pre-implementation group

Description:

Clinical use of hs-cTnI in patients with suspected acute coronary syndrome

Post-implementation group

Description:

Clinical use of hs-cTnT in patients with suspected acute coronary syndrome

Treatment:

Diagnostic Test: Clinical implementation of hs-cTnT

Sponsor of this trial

Lead Sponsor

University of Edinburgh