Serum troponin testing and adverse cardiovascular outcomes in supraventricular tachycardia: A retrospective study from TriNetX.

INTRODUCTION

Emergency department (ED) patients presenting with supraventricular tachycardia (SVT) often undergo laboratory testing, including troponin levels, despite previous literature suggesting an overall low prevalence of major adverse cardiac events (MACE) in this population. Better understanding of the prognostic utility of troponin in patients with SVT may help optimize disposition of these patients. We aimed to compare rates of 30-day MACE among SVT patients with serum troponin testing (YesTrop) versus those without (NoTrop).

METHODS

This retrospective, propensity-score-matched cohort study was completed using the TriNetX database. TriNetX includes data from 93 different large healthcare organizations (HCOs) with over 132 million patient records, including over 500,000 patients with a diagnosis of SVT presenting to an ED. Patients were included if they presented to ED with first-time SVT, with or without troponin testing. Patients were excluded if they had previous MACE history. Propensity-score matching was performed according to past medical history, triage vital signs, and laboratory markers. Statistical analyses, including risk analysis and outcome frequency, were conducted using TriNetX analytical tools.

RESULTS

The TriNetX database yielded a total of 225,778 patients meeting inclusion criteria with 31,291 included in each group after propensity score matching. Mean age (+/- Standard Deviation [SD] was 58 +/- 18 years), 17,043 (54.5 %) were female and a majority were white (69.8 %). Individual components of MACE with the greatest risk difference were acute myocardial infarct with a risk difference of -3.3 % (95 % CI -0.356 to -0.299, p < 0.001) and heart failure with a risk difference of -3.8 % (95 % CI -0.414 to -0.336, p < 0.001). Total MACE for the NoTrop group was 10.5 % (3816 events) vs 21.6 % (7826 events) in the YesTrop group (Risk difference 11.1 %, 95 % CI -0.11 to -0.116, P < 0.001). Higher percentage of YesTrop group had hospital diagnoses of hypertension, diabetes, and chronic respiratory diseases, including COPD, emphysema, and bronchitis.

CONCLUSION

In this study involving a large number of patients with SVT, patients who had serum troponin evaluation were associated with higher-risk of 30-day MACE events. However, patients who had troponin evaluation also had higher rates of comorbidity that might have prompted clinicians to check troponin. Until further studies are available, clinicians should exercise their clinical judgement in weighing the risks and benefits of ordering troponin on patients presenting with SVT.