Single high-sensitivity troponin levels to assess patients with potential acute coronary syndromes: 1-year outcomes

BACKGROUND: A pathway incorporating an option for early discharge based on a single low level of high-sensitivity cardiac troponin I (hs-cTnI) at presentation increases the proportion of patients presenting with a potential acute coronary syndrome (ACS) that can be discharged directly from the emergency department (ED), reducing length of stay without any increase in adverse events at 30 days. Here, we report the 1-year outcomes of patients managed using this pathway. METHODS: We recruited two cohorts of patients with a potential ACS, without high-risk features. The 'standard' cohort was managed according to the Australian national guidelines and the Single Troponin Accelerated Triage ('STAT') cohort was managed using the study pathway. 12-month outcomes were assessed using linked administrative data. RESULTS: Between May 2018 and October 2019, we recruited 2255 patients (1131 standard vs 1124 STAT), mean age 55 years, 53% male. 709 (63%) patients managed using the STAT pathway were discharged directly from ED, compared with 403 (38%) patients using the standard pathway, with a 47 min reduction in median hospital length of stay. At 12 months, there were no significant differences in unadjusted all-cause death (STAT 0.62% vs standard 0.97%, p=0.35) or myocardial infarction (MI) (STAT 0.62% vs standard 1.24%, p=0.13). CONCLUSIONS: A clinical pathway which incorporates early discharge based on a single low serum hs-cTnI is associated with an increased proportion of patients with a potential ACS discharged directly from the ED and reduced length of stay, without an increase in death or MI at 1 year.