Key result
Rapid 1-hour hs-cTnT pathway fails to reduce disposition decision time vs conventional 3-hour protocol.
Why the study?
The impact of a 1-hour high-sensitivity cardiac troponin-T pathway on emergency department patient flow and safety compared to a conventional 3-hour troponin pathway was uncertain.
Observational (n=1,892)
Blinded to study hypotheses
No
Absolute Event Rate: 4.8% vs 4.7%
p-value: p=0.428
1-hour hs-TnT pathway was not linked to faster disposition in observational data; leaves open randomized efficacy for ED throughput.
Study Objective To evaluate whether the introduction of a 1-hour high-sensitivity cardiac troponin-T (hs-TnT) pathway for patients who present to the emergency department (ED) with suspected acute coronary syndrome (ACS) improves ED patient flow without changing the rate of “missed” major adverse cardiac events (MACE), compared to use of conventional cardiac troponin with an associated 3-hour pathway. Methods This was a prospective, uncontrolled observational study conducted before and after implementation of a 1-hour hs-TnT pathway at a high-volume urban ED. Patients undergoing evaluation for ACS in the ED were enrolled during their initial visit and clinical outcomes were assessed at 30 and 90 days. Throughput markers were extracted from the electronic medical record and compared. The primary outcome was provider-to-disposition decision time. Results A total of 1892 patients were enrolled, 1071 patients while using conventional troponin and 821 after introduction of hs-TnT. With the new assay and pathway, median interval between troponin tests decreased from 4.7 hours (interquartile range [IQR] 3.9–5.7 hours) to 2.3 hours (IQR 1.5–3.4 hours) (P < 0.001). However, there was no difference in median provider-to-disposition decision time, which measured 4.7 hours (IQR 2.9–7.2) and 4.8 hours (IQR 3.1–7.1) (P = 0.428) respectively. Total 30-day MACE rate in discharged patients was low in both groups, occurring in only 4/472 (0.85%) encounters in the first cohort and 4/381 (1.0%) encounters in the second. Conclusion Introduction of a 1-hour hs-TnT ACS evaluation pathway reduced the troponin collection interval but did not reduce provider to disposition time. There was no difference in rate of 30-day MACE in patients discharged from the ED.
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Suh et al. (2022) conducted an observational in Suspected acute coronary syndrome (n=1,892). 1-hour high-sensitivity cardiac troponin-T (hs-TnT) pathway vs. Conventional cardiac troponin with an associated 3-hour pathway was evaluated on Provider-to-disposition decision time (median hours) (p=0.428). Introduction of a 1-hour high-sensitivity troponin-T pathway for suspected acute coronary syndrome did not reduce median provider-to-disposition decision time compared to a conventional 3-hour pathway (4.8 vs 4.7 hours, P=0.428).
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