Martin Jacob A, Zhang Robert S, Rhee Aaron J, Saxena Archana, Akindutire Olumide, Maqsood M Haisum, Genes Nicholas, Gollogly Nathan, Smilowitz Nathaniel R, Quinones-Camacho Adriana
Division of Cardiovascular Medicine New York University New York NY.
Department of Health Informatics NYU Grossman School of Medicine New York NY.
J Am Heart Assoc. 2025 May 20;14(10):e039322. doi: 10.1161/JAHA.124.039322. Epub 2025 Apr 16.
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.
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, [lt]0.001), shorter emergency department length of stay (5.5 versus 5.4 hours, =0.039), and lower admission rates (32.6% versus 38.2%, adjusted odds ratio [aOR], 0.74 [95% CI, 0.69-0.79]; [lt]0.0001). Hs-cTnI was also associated with lower odds of cardiology consultation (aOR, 0.91 [95% CI, 0.86-0.97]; =0.004), echocardiography (aOR, 0.86 [95% CI, 0.82-0.91]; [lt]0.001), stress tests (aOR, 0.74 [95% CI, 0.67-0.81]; [lt]0.001), and invasive coronary angiography (aOR, 0.77 [95% CI, 0.70-0.83]; [lt]0.001), but greater odds of computed tomography coronary angiography (aOR, 1.26 [95% CI, 1.01-1.56]; =0.03) and percutaneous coronary intervention (aOR, 1.40 [95% CI, 1.20-1.63]; [lt] 0.001) during the index encounter.
Implementation of the hs-cTnI assay was associated with reduced hospital admissions, shorter length of stay, and decreases in most downstream cardiac testing.
高敏心肌肌钙蛋白（hs-cTnI）检测可在低检测限下定量肌钙蛋白浓度，可能加快并改善心肌梗死的诊断。本研究调查了hs-cTnI检测在胸痛患者中应用于急诊室操作指标和下游心脏服务的实际影响。
我们对3个急诊科的胸痛患者进行了回顾性研究，这些患者均检测了≥1次肌钙蛋白浓度。我们比较了2021年1月至2022年3月（传统心肌肌钙蛋白I [cTnI]）与2022年4月至2023年3月（hs-cTnI检测实施后）的结果。主要结局是住院时间。该研究纳入了32076例急诊患者就诊（17267例检测cTnI，14809例检测hs-cTnI）。hs-cTnI检测的实施与总住院时间中位数缩短相关（6.6小时对vs 6.0小时，P＜0.001），急诊室停留时间缩短（5.5小时对vs 5.4小时，P = 0.039），以及入院率降低（32.6%对vs 38.2%，校正比值比[aOR]，0.74 [95%置信区间，0.69 - 0.79]；P＜0.0001）。hs-cTnI还与心脏病会诊几率降低相关（aOR，0.91 [95%置信区间，0.86 - 0.97]；P = 0.004），超声心动图检查几率降低（aOR，0.86 [95%置信区间，0.82 - 0.91]；P＜0.001），负荷试验几率降低（aOR，0.74 [95%置信区间，0.67 - 0.81]；P＜0.001），以及侵入性冠状动脉造影几率降低（aOR，0.77 [95%置信区间，0.70 - 0.83]；P＜0.001），但在首次就诊期间计算机断层扫描冠状动脉造影几率增加（aOR，1.26 [95%置信区间，1.01 - 1.56]；P = 0.03）和经皮冠状动脉介入几率增加（aOR，1.40 [95%置信区间，1.20 - 1.63]；P＜0.001）。
hs-cTnI检测的实施与住院人数减少、住院时间缩短以及大多数下游心脏检查减少相关。
