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Multicenter Study
. 2025 May 20;14(10):e039322.
doi: 10.1161/JAHA.124.039322. Epub 2025 Apr 16.

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

Jacob A Martin  1   2 , Robert S Zhang  3 , Aaron J Rhee  4 , Archana Saxena  1   2 , Olumide Akindutire  5 , M Haisum Maqsood  6 , Nicholas Genes  2   5 , Nathan Gollogly  2 , Nathaniel R Smilowitz  1 , Adriana Quinones-Camacho  1
Affiliations
Multicenter Study

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

Jacob A Martin et al. J Am Heart Assoc. .

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.

Keywords: chest pain; emergency department; high‐sensitivity; troponin.

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Conflict of interest statement

Dr Smilowitz is supported, in part, by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number K23HL150315. Dr Smilowitz serves on an advisory board/consultant for Abbott Vascular.

Figures

Figure 1
Figure 1. Density plot of total length of stay in hours for patients evaluated with a conventional troponin assay (red) and hs‐cTn (blue).
hs‐cTn indicates high‐sensitivity cardiac troponin.
Figure 2
Figure 2. Boxplot of ED length of stay in hours.
Boxes represent interquartile range and whiskers represent 1.5× first quartile and 1.5× third quartile. Outliers are not plotted. ED indicates emergency department.
Figure 3
Figure 3. Boxplot of total length of stay in hours.
Boxes represent interquartile range and whiskers represent 1.5× first quartile and 1.5× third quartile. Outliers are not plotted.
Figure 4
Figure 4. Number of troponin results and time difference between measurements before (conventional troponin) and after implementation of high‐sensitivity troponin testing.
A, Number of troponin results before and after implementation. B, Time difference between first and second troponin.
Figure 5
Figure 5. Utilization rates of key tests and procedures before and after initiation of high‐sensitivity troponin.
CABG indicates coronary artery bypass graft; cath, invasive coronary angiogram; CCTA, coronary computed tomography angiogram; and PCI, percutaneous coronary intervention. *Signifies a statistically significant P value.
See this image and copyright information in PMC

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