High-sensitivity cardiac troponin assay use was associated with more echocardiography in NSTE-ACS (aOR 1.43; 95% CI 1.19-1.73) and less invasive angiography in low-risk patients.
Observational (n=251,000)
Yes
Odds Ratio: 1.43 (95% CI 1.19–1.73)
Absolute Event Rate: 82.4% vs 75%
Background: Few data exist regarding the implementation of high-sensitivity cardiac troponin (hs-cTn) assays in the United States since their approval. Objectives: To explore trends in hs-cTn assay implementation over time and assess the association of their use with in-hospital cardiac testing and outcomes. Methods: We examined trends in implementation of hs-cTn assays among participating hospitals in the NCDR® Chest Pain-MI Registry from 1/1/2019 through 9/30/2021. Associations between hs-cTn use, use of in-hospital diagnostic imaging, and patient outcomes were assessed using generalized estimating equation models with logistic or Gamma distributions. Results: Among 550 participating hospitals (251,000 patients), implementation of hs-cTn assays increased from 3.3% in Q1, 2019 to 32.6% in Q3, 2021 (Ptrend<0.001). hs-cTn use was associated with more echocardiography among persons with NSTE-ACS (82.4% vs. 75.0%; aOR: 1.43, 95% CI, 1.19–1.73) but not among low-risk chest pain individuals. hs-cTn use was associated with less invasive coronary angiography among low-risk patients (3.7% vs. 4.5%; aOR: 0.73, 95% CI, 0.58–0.92) but similar use for NSTE-ACS. There was no association between hs-cTn use and non-invasive stress/CTCA testing. Among NSTE-ACS individuals, hs-cTn use was not associated with revascularization or in-hospital mortality. Use of hs-cTn was associated with shorter length of stay (LOS; median 47.6 hours vs. 48.0 hours; ratio: 0.94, 95% CI, 0.90–0.98). Conclusions: Implementation of hs-cTn among U.S. hospitals is increasing but most U.S hospitals continue to use less-sensitive assays. hs-cTn use was associated with modestly shorter LOS, greater use of echocardiography for NSTE-ACS, and less use of invasive angiography among low-risk patients.
“High-sensitivity cardiac troponin is the preferred biomarker for evaluating acute chest pain according to the 2021 American College of Cardiology/American Heart Association guideline for the evaluation and diagnosis of chest pain; providing a class 1 recommendation. We examined the implementation of high-sensitivity cardiac troponin assays among participating hospitals in the National Cardiovascular Data Registry (NCDR) Chest Pain-MI Registry in the United States. We found that, although implementation is increasing, only one-third of hospitals had implemented these assays by the third quarter of 2021. We found use of high-sensitivity cardiac troponin was associated with a slightly shorter length of hospital stay, more use of echocardiography for non-ST segment elevation ACS and less use of invasive angiography in low-risk chest pain patients.”
McCarthy et al. (Mon,) conducted a observational in Chest pain and myocardial infarction (n=251,000). High-sensitivity cardiac troponin (hs-cTn) assays vs. Less-sensitive cardiac troponin assays was evaluated on Echocardiography use among persons with NSTE-ACS (aOR 1.43, 95% CI 1.19-1.73). High-sensitivity cardiac troponin assay use was associated with more echocardiography in NSTE-ACS (aOR 1.43; 95% CI 1.19-1.73) and less invasive angiography in low-risk patients.
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