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. 2025 May 15:14:100103.
doi: 10.1016/j.ajmo.2025.100103. eCollection 2025 Dec.

Implementation of High-Sensitivity Troponin for Early Rule-Out of Acute Myocardial Infarction in Emergency Department

Alexandra M Cruz Pabón  1 , Eric Pyles  1 , Daniel Peach  2 , Sarfraz Ahmad  3 , Paul Blake O'Brien  4 , Michael Kuhlman  2 , Sarah Steiner  2 , Lara Crown  5 , Elizabeth Purinton  5 , James Priano  1
Affiliations

Implementation of High-Sensitivity Troponin for Early Rule-Out of Acute Myocardial Infarction in Emergency Department

Alexandra M Cruz Pabón et al. Am J Med Open. .

Abstract

Background/purpose: Chest pain is a common reason for ED visits. Implementing a HEART score-based algorithm previously increased early discharges by 99%. This study aims to determine if the transition from cTnT to hs-cTnT assays affected patient disposition rates.

Methods: This retrospective observational study was conducted in a multi-site hospital system. Adults presenting to the ED with chest pain and a low HEART score (≤3) between November 9, 2020, and November 10, 2022, were included. The primary outcome was the change in patient disposition. Secondary outcomes included length-of-stay (LOS), rates of provocative testing, ED returns, and major adverse cardiovascular events (MACE).

Results: We evaluated 32,968 patients (17,173 in the cTnT group and 15,795 in the hs-cTnT group). Both groups had a similar median age, but the hs-cTnT group had a higher proportion of patients with baseline troponin elevations. The ED discharge rate was higher in the hs-cTnT group (87.5%) compared to the cTnT group (85.3%; P < .001), with a corresponding decrease in observation and inpatient admissions. Additionally, the implementation of hs-cTnT was associated with a reduced LOS and a decrease in patients undergoing further testing. Finally, there was a reduction in ED re-visits without a difference in 30- or 60-day MACE after the implementation of hs-cTnT.

Conclusions: Integration of hs-cTnT into our chest pain clinical pathway resulted in increased ED discharges, reduced LOS, and fewer additional tests without a change in MACE. This translates to a savings of almost 7,000 ED hours annually without compromising safety.

Keywords: Acute myocardial Infarction; Chest pain; Clinical pathways; Emergency department; Length-of-stay; Patient disposition rate; Quality improvement; Troponin.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image, graphical abstract
Graphical abstract
Figure 1
Figure 1
Participant flow diagram. Abbreviations: HEART, History, Electrocardiogram, Age, Risk factors, Troponin; LWBS, left without being seen; AMA, against medical advice; cTn, conventional troponin; hs-cTn, high-sensitivity troponin.
Figure 2
Figure 2
Chest pain pathway for patients with a low (≤3) HEART score. Abbreviations: HEART, History, Electrocardiogram, Age, Risk factors, Troponin; cTn, conventional troponin; hs-cTn, high-sensitivity troponin; PCP, primary care physician.
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