A high-sensitivity troponin T assay has been shown to improve evaluation of patients complaining of chest pain.

At the Karolinska Institute, Sweden, researchers studying patients discharged from an emergency clinic found that their risk of suffering a serious cardiovascular event within 30 days of returning home was much lower when the new method was in use than when examinations used older versions of the test. The percentage of those subsequently suffering a heart attack, dying, or undergoing unplanned revascularization dropped from 0.9% to 0.6%.

To rule out myocardial infarction, doctors normally check the patient’s electrocardiogram (ECG) and perform a blood test for the cardiac biomarkers troponin I or troponin T. In recent years, however, a new and more sensitive assay has been introduced at Swedish hospitals. Previous studies have shown this high-sensitivity troponin T assay to be more diagnostically accurate, but it has not been previously known whether this accuracy applies to clinical procedures.

The large-scale registry study examined 65,000 patients with unspecified chest pain who had been discharged from 16 Swedish emergency clinics between 2006 and 2013.

Per Svensson, Karolinska Institute.

Per Svensson, Karolinska Institute.

“Our results are of interest to other countries such as the United States, which is about to change its methods,” says Per Svensson, associate professor and senior lecturer at the Karolinska Institute’s department of medicine.

However, among patients who had been discharged from hospital after being admitted for an unspecified chest pain diagnosis, the risk of suffering serious events increased after the change in method. In this group, 7.2% of patients examined with the new method were affected, compared to 3.4% of patients who were examined in the former way. These particular patients also had a higher risk profile after the change in method.

“We may conclude from the results of our study that examination using high-sensitivity troponin is associated with fewer serious cardiac events and an improvement in risk profile for patients released from emergency clinics with unspecified chest pain,” says Svensson. “The opposite was observed in patients sent home after admission to hospital, which suggests that high-risk patients are identified and hospitalized more frequently. We therefore conclude that high-sensitivity troponin has helped to improve the evaluation of emergency patients with unspecified chest pain.”

The study was financed by the Karolinska Institute.


1. Nejatian A, Omstedt Å, Höijer J, et al. Outcomes in patients with chest pain discharged after evaluation using a high-sensitivity troponin T assay. J Am Coll Cardiol. 2017;69(21):2622–2630; doi:10.1016/j.jacc.2017.03.586.