High-Sensitivity Troponin Offers AMI Diagnostic Edge

TOPLINE:

Implementing the high-sensitivity troponin (hsTn)-based HEART pathway in US emergency departments (EDs) improves acute myocardial infarction (AMI) diagnosis.

METHODOLOGY:

• This multicenter pre-post cohort study was conducted across 16 Kaiser Permanente Southern California hospitals.
• The study analyzed the data of 17,384 adult patients who presented to an ED with chest pain and underwent cardiac risk stratification with a HEART pathway using conventional troponin (cTn) or hsTn.
• Among the 17,384 patients, 12,440 underwent cTn testing, whereas 4944 underwent hsTn testing.

TAKEAWAY:

• The rate of AMI detection within 30 days was significantly higher in the hsTn vs cTn group (5.8% vs 4.4%; P <.001); however, the 30-day all-cause mortality rate was similar between the groups (P = .50).
• In the ED, AMI diagnosis rates were significantly higher in the hsTn vs cTn group (4.6% vs 2.0%; P <.001).
• However, within 30 days after the index ED visit, AMI diagnosis rates were significantly higher in the cTn vs hsTn group (2.4% vs 1.2%; P < .001).
• In the hsTn vs cTn group, the rates of admission, stress testing within 7 days, and coronary revascularization within 30 days were significantly lower (all P <.001).

IN PRACTICE:

“An hsTn algorithm may improve the ED evaluation of AMI, both catching AMI earlier and mitigating unnecessary admission and advanced testing,” the authors concluded.

SOURCE:
The study, with lead author Mackensie Yore, MD, MS, Department of Emergency Medicine, Veterans Affairs/University of California Los Angeles National Clinician Scholars Program, Los Angeles, was published online on December 19, 2023, in JAMA Network Open.

LIMITATIONS:

• The study was limited to an integrated healthcare system, possibly affecting generalizability.
• This study was conducted during the COVID-19 pandemic with a restricted follow-up duration, potentially influencing healthcare utilization.

DISCLOSURES:

The study was supported by a grant from the National Institutes of Health (NIH). Some authors reported receiving grants or personal fees from various sources, including the NIH.