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Same-Day Discharge is Safe in Patients with Low-Level Troponin Elevation post-PCI
520
Abstracts Abstracts
Heart, Lung and Circulation 2012;21:480–526
ABSTRACTS
Same-Day Discharge is Safe in Patients with Low-Level Troponin Elevation post-PCI I.G. Webb 1,2,∗ , M.B. Simmonds 1,2 , P.D. Larsen 1,3 , S.A. Harding 1,2
Conclusion: In the setting of an established day-case PCI program with clear clinical guidance for patient management, same-day discharge of patients with lowlevel TnT release is safe and not associated with adverse events.
1 Wellington Cardiovascular Research Group, Wellington, New
http://dx.doi.org/10.1016/j.hlc.2012.03.109
Zealand 2 Cardiology
Department, Wellington Hospital, Wellington,
New Zealand 3 Department of Surgery and Anaesthesia, University of Otago,
Wellington, New Zealand Background: Same-day discharge following PCI reduces bed occupancy, is cost effective and popular with patients. Low-level elevations of troponin T (TnT) following PCI are common. Outcomes following same-day discharge of PCI patients with low-level TnT elevation are currently unknown. Methods: We prospectively studied a cohort of 885 patients undergoing elective PCI between May 2006 and December 2010 at our institution. All patients had TnT measured 6 h post procedure. Decisions regarding the suitability of same-day discharge were made 6 h post procedure. Patients with a suboptimal angiographic result, evidence of periprocedural ischaemia or infarction (prolonged chest pain, ECG changes or TnT > 0.15 g/mL), access site complications, requiring a glycoprotein IIb/IIIa infusion or inadequate social circumstances were admitted. Demographic, procedural and outcomes data at 24-h and 30 days were recorded. Results: Of 774 TnT negative patients, 698 (90.2%) were successfully discharged home on the same day (Group 1). Post-procedural TnT elevation (>0.03 g/mL) was observed in 101 patients, of whom 52 were discharged home same day (Group 2). The mean TnT level in this group was 0.07 g/mL. There was no MACE (death, MI, stent thrombosis or TVR) within 24 h of discharge in either group 1 or group 2. Readmission for any reason within 24 h was rare and did not differ between group 1 and group 2. Similarly, 30-day outcomes were comparable between groups. Group 1 TnT negative same day discharge
Group 2 TnT positive same day discharge
No. of patients Mean TnT (g/mL)
698 <0.03
52 0.07
Outcome
24-h
Death Re-admission MI Stent thrombosis TVR Other *
0 5 (0.7%) 0 0 0 5 (0.7%)
30-day 0 27 (3.9%) 3 (0.4%) 2 (0.3%) 1 (0.1%) 24 (3.4%)
24-h 0 1 (1.9%) 0 0 0 1 (1.9%)
30-day 0 4 (7.6%) 0 0 0 4 (7.6%)
All comparisons between groups at 24-h and 30 days non-significant.
Elevated Baseline Cardiac Troponin Levels in the Elderly—Another Variable to Consider? I.G. Webb 1,2,∗ , S.T. Yam 3 , R. Cooke 4 , A. Aitken 1,2 , P.D. Larsen 1,3 , S.A. Harding 1,2,5 1 Wellington Cardiovascular Research Group, Wellington, New
Zealand 2 Department
of Cardiology, Wellington Hospital, Wellington, New Zealand 3 University of Otago, Wellington, New Zealand 4 Laboratory Services, Wellington Hospital, Wellington, New Zealand 5 Victoria University of Wellington, Wellington, New Zealand Background: High-sensitivity Troponin T (hs-TnT) is now widely employed in the diagnosis of myocardial infarction. Inappropriate “rule in” or delayed “rule out” of myocardial infarction has significant consequences. It is therefore important to understand factors that influence baseline levels of hs-TnT. We sought to determine the impact of increasing age on baseline hs-TnT levels. Methods: We retrospectively reviewed all patients with hs-TnT measurements in our Emergency Department between November 2010 and June 2011. Those with a presentation suggestive of ACS, a significant rise or fall in hs-TnT or other acute illness know to elevate hs-TnT were excluded. Demographics, clinical details and laboratory investigations were obtained from the medical records. Results: Of 3219 patients with hs-TnT measurements taken, 615 were excluded because of suspected ACS and 1287 for other reasons, including impaired renal function (eGFR < 45 ml/h/m2 ), arrhythmia, sepsis and acute heart failure. Of the remaining 1317 patients, 39.6% were male and the median age was 63 years (16–101). Multivariate analysis identified increasing age (p < 0.001) as the strongest independent predictor of elevated hs-TnT. Other independent predictors included prior myocardial infarction (p = 0.01), atrial fibrillation (p < 0.001), gender (p < 0.0001), smoking (p = 0.04), renal dysfunction (p < 0.0001) and hypertension (p < 0.005). Analysis of hsTnT percentiles by age is shown in Fig. 1.
Abstracts Abstracts
Heart, Lung and Circulation 2012;21:480–526
ABSTRACTS
Same-Day Discharge is Safe in Patients with Low-Level Troponin Elevation post-PCI I.G. Webb 1,2,∗ , M.B. Simmonds 1,2 , P.D. Larsen 1,3 , S.A. Harding 1,2
Conclusion: In the setting of an established day-case PCI program with clear clinical guidance for patient management, same-day discharge of patients with lowlevel TnT release is safe and not associated with adverse events.
1 Wellington Cardiovascular Research Group, Wellington, New
http://dx.doi.org/10.1016/j.hlc.2012.03.109
Zealand 2 Cardiology
Department, Wellington Hospital, Wellington,
New Zealand 3 Department of Surgery and Anaesthesia, University of Otago,
Wellington, New Zealand Background: Same-day discharge following PCI reduces bed occupancy, is cost effective and popular with patients. Low-level elevations of troponin T (TnT) following PCI are common. Outcomes following same-day discharge of PCI patients with low-level TnT elevation are currently unknown. Methods: We prospectively studied a cohort of 885 patients undergoing elective PCI between May 2006 and December 2010 at our institution. All patients had TnT measured 6 h post procedure. Decisions regarding the suitability of same-day discharge were made 6 h post procedure. Patients with a suboptimal angiographic result, evidence of periprocedural ischaemia or infarction (prolonged chest pain, ECG changes or TnT > 0.15 g/mL), access site complications, requiring a glycoprotein IIb/IIIa infusion or inadequate social circumstances were admitted. Demographic, procedural and outcomes data at 24-h and 30 days were recorded. Results: Of 774 TnT negative patients, 698 (90.2%) were successfully discharged home on the same day (Group 1). Post-procedural TnT elevation (>0.03 g/mL) was observed in 101 patients, of whom 52 were discharged home same day (Group 2). The mean TnT level in this group was 0.07 g/mL. There was no MACE (death, MI, stent thrombosis or TVR) within 24 h of discharge in either group 1 or group 2. Readmission for any reason within 24 h was rare and did not differ between group 1 and group 2. Similarly, 30-day outcomes were comparable between groups. Group 1 TnT negative same day discharge
Group 2 TnT positive same day discharge
No. of patients Mean TnT (g/mL)
698 <0.03
52 0.07
Outcome
24-h
Death Re-admission MI Stent thrombosis TVR Other *
0 5 (0.7%) 0 0 0 5 (0.7%)
30-day 0 27 (3.9%) 3 (0.4%) 2 (0.3%) 1 (0.1%) 24 (3.4%)
24-h 0 1 (1.9%) 0 0 0 1 (1.9%)
30-day 0 4 (7.6%) 0 0 0 4 (7.6%)
All comparisons between groups at 24-h and 30 days non-significant.
Elevated Baseline Cardiac Troponin Levels in the Elderly—Another Variable to Consider? I.G. Webb 1,2,∗ , S.T. Yam 3 , R. Cooke 4 , A. Aitken 1,2 , P.D. Larsen 1,3 , S.A. Harding 1,2,5 1 Wellington Cardiovascular Research Group, Wellington, New
Zealand 2 Department
of Cardiology, Wellington Hospital, Wellington, New Zealand 3 University of Otago, Wellington, New Zealand 4 Laboratory Services, Wellington Hospital, Wellington, New Zealand 5 Victoria University of Wellington, Wellington, New Zealand Background: High-sensitivity Troponin T (hs-TnT) is now widely employed in the diagnosis of myocardial infarction. Inappropriate “rule in” or delayed “rule out” of myocardial infarction has significant consequences. It is therefore important to understand factors that influence baseline levels of hs-TnT. We sought to determine the impact of increasing age on baseline hs-TnT levels. Methods: We retrospectively reviewed all patients with hs-TnT measurements in our Emergency Department between November 2010 and June 2011. Those with a presentation suggestive of ACS, a significant rise or fall in hs-TnT or other acute illness know to elevate hs-TnT were excluded. Demographics, clinical details and laboratory investigations were obtained from the medical records. Results: Of 3219 patients with hs-TnT measurements taken, 615 were excluded because of suspected ACS and 1287 for other reasons, including impaired renal function (eGFR < 45 ml/h/m2 ), arrhythmia, sepsis and acute heart failure. Of the remaining 1317 patients, 39.6% were male and the median age was 63 years (16–101). Multivariate analysis identified increasing age (p < 0.001) as the strongest independent predictor of elevated hs-TnT. Other independent predictors included prior myocardial infarction (p = 0.01), atrial fibrillation (p < 0.001), gender (p < 0.0001), smoking (p = 0.04), renal dysfunction (p < 0.0001) and hypertension (p < 0.005). Analysis of hsTnT percentiles by age is shown in Fig. 1.