Work

Real‐World Clinical Impact of High‐Sensitivity Troponin for Chest Pain Evaluation in the Emergency Department

Year: 2025

Type: article

Abstract: Background High‐sensitivity cardiac troponin (hs‐cTnI) assays can quantify troponin concentrations with low limits of detection, potentially expediting and enhancing myocardial infarction diagnoses. This study investigates the real‐world impact of hs‐cTnI implementation on operational metrics and downstream cardiac services in patients presenting to the emergency department with chest pain. Methods and Results We conducted a retrospective study of patients who presented to 3 emergency departments for chest pain and in whom ≥1 troponin concentration was measured. We compared outcomes from January 2021 to March 2022 (conventional cardiac troponin I [cTnI]) against outcomes from April 2022 to March 2023 (post‐hs‐cTnI implementation). The primary outcome was hospital length of stay. The study included 32 076 emergency department patient‐visits (17 267 with cTnI, 14 809 with hs‐cTnI). Implementation of hs‐cTnI was associated with shorter median total length of stay (6.6 versus 6.0 hours, P [lt]0.001), shorter emergency department length of stay (5.5 versus 5.4 hours, P =0.039), and lower admission rates (32.6% versus 38.2%, adjusted odds ratio [aOR], 0.74 [95% CI, 0.69–0.79]; P [lt]0.0001). Hs‐cTnI was also associated with lower odds of cardiology consultation (aOR, 0.91 [95% CI, 0.86–0.97]; P =0.004), echocardiography (aOR, 0.86 [95% CI, 0.82–0.91]; P [lt]0.001), stress tests (aOR, 0.74 [95% CI, 0.67–0.81]; P [lt]0.001), and invasive coronary angiography (aOR, 0.77 [95% CI, 0.70–0.83]; P [lt]0.001), but greater odds of computed tomography coronary angiography (aOR, 1.26 [95% CI, 1.01–1.56]; P =0.03) and percutaneous coronary intervention (aOR, 1.40 [95% CI, 1.20–1.63]; P [lt] 0.001) during the index encounter. Conclusion Implementation of the hs‐cTnI assay was associated with reduced hospital admissions, shorter length of stay, and decreases in most downstream cardiac testing.

Source: Journal of the American Heart Association

DOI: 10.1161/jaha.124.039322