Clinical and Economic Implications of High-Sensitivity Troponin-Informed Admission Strategies in Non-AMI Chest Pain

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Non-AMI chest pain with detectable baseline hs-cTnI (n=1481). Intervention: Modeled admission pathway using hs-cTnI ≥ 5 ng/L and HEAR score ≥ 4 vs. Standard-of-care admissions. Primary outcome: Hospital admission rate (p=<0.05).

Q: What does this research mean for the field?

A modeled admission pathway incorporating sub-99th percentile hs-cTnI thresholds (≥ 5 ng/L) alongside risk scores reduces hospital admissions and diagnostic costs compared to standard-of-care while maintaining 93% sensitivity for 30-day death or myocardial infarction in non-AMI chest pain patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Wanyi Chen; Allan S. Jaffe; Fred S. Apple; Christopher deFilippi; William Frank Peacock; Alan H. B. Wu; Rana Fayyad; Sarah Bethoney; Jingjing Zhang; Artem T. Boltyenkov

doi:10.3390/jcdd13070328

July 14, 2026Journal of Cardiovascular Development and DiseaseOpen Access

Clinical and Economic Implications of High-Sensitivity Troponin-Informed Admission Strategies in Non-AMI Chest Pain

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Why the study?

Post-AMI rule-out disposition remains variable in non-AMI chest pain patients, and the economic value of hs-cTnI-guided hospitalizations among these patients is unclear.

Does a modeled admission pathway incorporating sub-99th percentile hs-cTnI thresholds and HEAR scores reduce hospital admissions and costs compared to standard-of-care in patients with non-AMI chest pain and detectable hs-cTnI?

Key Points

To evaluate the diagnostic performance and economic implications of incorporating sub-99th percentile high-sensitivity cardiac troponin I thresholds and risk scores to guide hospital admissions in non-AMI chest pain.
Analyzed 1481 non-AMI chest pain visits with detectable baseline hs-cTnI across 29 U.S. emergency departments (2014–2016) in the prospective HIGH-US trial using the Atellica IM TnIH assay.
Compared observed standard-of-care hospital admissions against modeled pathways combining baseline hs-cTnI thresholds (such as ≥ 5 ng/L) with non-low HEAR risk scores.
Assessed admission rates, 30-day death or myocardial infarction outcomes, diagnostic performance metrics, and estimated per-patient costs across noninvasive and invasive care scenarios.
Overall 30-day death or MI occurred in 1.0% (n = 15/1481) of visits, with standard-of-care admitting 59% (879/1481) of patients with 93% sensitivity (14/15) and 41% specificity (601/1466).
A modeled pathway using hs-cTnI ≥ 5 ng/L and non-low risk scores projected an admission rate of 41%, maintaining 93% sensitivity while increasing specificity to 60%.
Estimated per-patient diagnostic costs under the modeled pathway fell from $1139 to $1025 for noninvasive testing alone (Scenario 1) and from $3536 to $2672 when including inpatient procedures (Scenario 2).

Study Design

Type

Observational (n=1,481)

Multicenter

Yes

Structured PICO

Does a modeled admission pathway incorporating sub-99th percentile hs-cTnI thresholds and HEAR scores reduce hospital admissions and costs compared to standard-of-care in patients with non-AMI chest pain and detectable hs-cTnI?

P

Population

1,481 adults with suspected acute coronary syndrome, ruled-out AMI, and detectable baseline hs-cTnI across 29 U.S. emergency departments, followed for 30 days.

E

Exposure

Modeled hospital admission pathways integrating HEAR scores (≥4) with presenting sub-99th percentile hs-cTnI concentrations (e.g., ≥5 ng/L).

C

Comparator

Observed standard-of-care (SOC) admissions.

O

Outcome

Admission rates, per-patient costs, and diagnostic accuracy (sensitivity, specificity, negative predictive value) for 30-day death or myocardial infarction.composite

Main Result

Absolute Event Rate: 41% vs 59%

p-value: p=<0.05

Incorporating sub-99th percentile hs-cTnI thresholds alongside clinical risk scores for non-AMI chest pain patients may safely reduce unnecessary hospital admissions and healthcare costs.

Limitations

hs-cTnI-based admission criteria were retrospectively applied
emergency department workflows, admission practices, laboratory turnaround times, and reimbursement mechanisms vary substantially
conservatively assumed that all noninvasive diagnostic testing occurred in an outpatient setting
inferred inpatient facility payments based on utilization of invasive procedures
small number of events limits precision
hs-cTnI-based admission criteria were retrospectively applied.
Emergency department workflows, admission practices, and costs vary substantially, limiting generalizability.
Assumed all noninvasive diagnostic testing occurred in an outpatient setting, which may underestimate costs.
Inferred inpatient facility payments based on utilization of invasive procedures due to lack of DRG codes.
Assumed resource utilization intensity mirrored the HIGH-US cohort.
Trial conducted between 2015 and 2016 may not fully reflect contemporary practice patterns.
Excluded patients with undetectable hs-cTnI.
Small number of events limits precision.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May reduce projected admissions in non-AMI chest pain; leaves open prospective validation before practice change.

Abstract

Most patients with chest pain do not have acute myocardial infarction (AMI), yet post-AMI rule-out disposition remains variable. Detectable but sub-99th percentile high-sensitivity cardiac troponin I (hs-cTnI) provides additional prognostic information. We evaluated the economic value of hs-cTnI-guided hospitalizations among non-AMI patients. We analyzed 1481 non-AMI chest pain visits with detectable baseline hs-cTnI across 29 U.S. emergency departments (2014–2016) in the prospective HIGH-US trial using the Atellica IM TnIH assay(Siemens Healthcare Diagnostics, Tarrytown, NY, US). We compared observed standard-of-care admissions with modeled pathways incorporating hs-cTnI thresholds and risk scores, assessing admission rates, costs, and diagnostic accuracy for 30-day death/MI. Overall, 1.0% (n = 15/1481) experienced 30-day death/MI. Standard-of-care admitted 59% of patients with 93% sensitivity and 41% specificity. The modeled pathway using hs-cTnI ≥ 5 ng/L plus non-low risk scores was associated with reduced projected admission of 41%, higher specificity of 60%, and the same 93% sensitivity. Estimated per-patient diagnostic costs were lower under Scenario 1 (noninvasive diagnostic testing only; $1025 vs. $1139) and under Scenario 2 (including inpatient/invasive procedures; $2672 vs. $3536). In subgroups, higher hs-cTnI thresholds conferred further economic benefit without compromising sensitivity. Incorporating sub-99th percentile hs-cTnI thresholds alongside risk scores may support more efficient resource use while maintaining safety, although findings require prospective validation.

Discussion

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Cite This Study

Chen et al. (2026) conducted an observational in Non-AMI chest pain with detectable baseline hs-cTnI (n=1,481). Modeled admission pathway using hs-cTnI ≥ 5 ng/L and HEAR score ≥ 4 vs. Standard-of-care admissions was evaluated on Hospital admission rate (p=<0.05).

synapsesocial.com/papers/6a5875f72b46c88ba9ad1acf https://doi.org/10.3390/jcdd13070328

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Clinical and Economic Implications of High-Sensitivity Troponin-Informed Admission Strategies in Non-AMI Chest Pain

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Clinical and Economic Implications of High-Sensitivity Troponin-Informed Admission Strategies in Non-AMI Chest Pain

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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