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

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

Jacob A. Martin, Robert S. Zhang, Aaron J. Rhee, Archana Saxena, Olumide Akindutire, M. Haisum Maqsood, Nicholas Genes, Nathan Gollogly, Nathaniel R. Smilowitz, Adriana Quinones-Camacho
 Journal of the American Heart Association, April 16, 2025

📌 Clinical Takeaway:

The introduction of hs-cTnI testing in the ED led to:

  • Reduced hospital admissions and LOS

  • Fewer downstream tests and consults

  • Increased early identification of patients needing PCI

This supports hs-cTnI as an efficient diagnostic tool that streamlines care and improves resource utilization for ED patients with chest pain.

🔍 Key Findings:

  • Study Design:

    • Retrospective study comparing ED patient encounters for chest pain before and after implementation of high-sensitivity cardiac troponin I (hs-cTnI) across three emergency departments.

    • Periods compared:

      • Conventional cTnI: Jan 2021 – Mar 2022

      • hs-cTnI: Apr 2022 – Mar 2023

    • Sample size: 32,076 encounters (17,267 with cTnI, 14,809 with hs-cTnI)

  • Primary Outcome:

    • Hospital length of stay (LOS)

      • Median LOS reduced: 6.6 hours → 6.0 hours (P < 0.001)

  • Secondary Operational Metrics:

    • ED LOS: Slightly decreased (5.5 → 5.4 hours, P = 0.039)

    • Hospital admissions: Decreased (38.2% → 32.6%; aOR 0.74, 95% CI 0.69–0.79)

    • Cardiac testing/consultations decreased:

      • Cardiology consults: aOR 0.91

      • Echocardiography: aOR 0.86

      • Stress testing: aOR 0.74

      • Invasive coronary angiography: aOR 0.77

    • Imaging/testing that increased:

      • CT coronary angiography: aOR 1.26

      • PCI during index visit: aOR 1.40

Martin, J.A., Zhang, R.S., Rhee, A.J., Saxena, A., Akindutire, O., Maqsood, M.H., Genes, N., Gollogly, N., Smilowitz, N.R. and Quinones‐Camacho, A., 2023. Real‐World Clinical Impact of High‐Sensitivity Troponin for Chest Pain Evaluation in the Emergency Department. Journal of the American Heart Association, p.e039322.

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