Comparison of High-Sensitivity Troponin T Assay to Conventional Troponin T Assay for Rule Out of Acute Coronary Syndrome in the Emergency Department

Approximately 5% of all emergency department (ED) visits require evaluation of chest pain and atypical symptoms for diagnosis or exclusion of myocardial infarction or acute coronary syndrome (ACS) (P. ). Health care providers rely on effective tests and assessment protocols for definitive diagnosis of ACS. Cardiac biomarkers in troponin T assays enable rapid exclusion of ACS. This project compared high-sensitivity troponin T assay to conventional troponin T assay in reducing unnecessary stress tests for ACS exclusion, length of stay in the ED, and rate of readmissions within 30 days after ACS exclusion and discharge. A retrospective review of 300 medical records for exclusion of ACS compared 150 patients receiving conventional troponin T assay and 150 patients receiving high-sensitivity troponin T assay. The mean length of stay in the preintervention group was 8.3 hr (SD = 1.60) compared with 3.9 hr (SD = 1.56) in the postintervention group (t(298) = 24.56, p < 0.001). A significant difference was found in necessary and unnecessary stress testing (X(1) =17.42, p < 0.05). The preintervention group had significantly more normal stress tests and the postintervention group had significantly more abnormal stress tests. In the preintervention group, 4 (2.7%) patients were readmitted within 30 days with ACS; no readmissions were reported for the postintervention group. Findings supported outcome improvements with the high-sensitivity troponin T assay. Using high-sensitivity troponin T assay in the diagnosis protocol can improve length of stay for patients with exclusion of ACS and reduce unnecessary stress tests during the ED stay.