Association of an Accelerated High-Sensitivity Cardiac Troponin-Anchored Care Pathway With 30-Day Mortality and Intensive Care Outcomes in Acute Coronary Syndrome: A Retrospective Cohort Study

Background: Acute coronary syndrome causes substantial short-term mortality, cardiovascular complications, and intensive care use. High-sensitivity cardiac troponin within an accelerated care pathway may support earlier recognition and management. Objective: To assess the association between an accelerated high-sensitivity cardiac troponin-anchored care pathway and 30-day mortality and intensive care outcomes in acute coronary syndrome. Methods: This retrospective cohort study was conducted at the Department of Internal Medicine, University at Buffalo, New York, from April 2024 to April 2025. Records of 200 patients were reviewed: 100 managed through the accelerated pathway and 100 receiving standard care. The pathway was defined as definitive clinical action within three hours based on troponin findings, clinical assessment, and electrocardiography. The primary outcome was 30-day all-cause mortality; secondary outcomes were exploratory. Results: Measured baseline characteristics did not differ significantly. Time to definitive decision was shorter with the accelerated pathway (2.1 ± 0.6 vs. 5.7 ± 1.8 hours; p<0.001). Thirty-day mortality was 7.0% vs. 16.0%, with an absolute risk difference of −9.0 percentage points (95% confidence interval: −17.8 to −0.2; p=0.046). Acute heart failure, malignant arrhythmias, cardiogenic shock, intensive care unit admission, and hospital stay were lower in exploratory unadjusted analyses. Exploratory multivariable analysis showed an association with lower 30-day mortality (adjusted odds ratio: 0.40; 95% confidence interval: 0.16-0.98; p=0.045). Conclusion: The accelerated pathway was associated with lower observed mortality and fewer short-term complications. Causal conclusions cannot be drawn because of the retrospective, non-randomized design and potential residual confounding.