Key result
High-sensitivity HEART Pathway one-and-done strategy is linked to a ~0.2% 30-day death or MI rate.
Why the study?
The safety and effectiveness of the high-sensitivity HEART Pathway one-and-done troponin strategy for acute chest pain patients was not established.
Does the high-sensitivity HEART Pathway one-and-done strategy safely identify low-risk emergency department patients with acute chest pain for rapid discharge?
Cohort (n=12,190)
Yes
Does the high-sensitivity HEART Pathway one-and-done strategy safely identify low-risk emergency department patients with acute chest pain for rapid discharge?
The 'one-and-done' hs-HEART Pathway strategy is a safe and effective method for rapidly evaluating and discharging low-risk patients with acute chest pain, yielding an extremely low 30-day rate of mortality or MI.
The high-sensitivity History, Electrocardiogram (ECG), Age, Risk factor, and Troponin (HEART) Pathway (hs-HP) includes a "one-and-done" strategy where patients with a non-ischemic ECG, no known coronary artery disease, HEAR score ≤3, and chest pain duration >3 hours can be discharged with a single very-low high-sensitivity troponin (hs-cTnI) measure <4 ng/L. We aimed to evaluate the safety and effectiveness of this "one-and-done" hs-cTn strategy using a multisite emergency department cohort of patients with acute chest pain (N=12,190). Among these, 13.4% (1,628/12,190) were eligible for the one-and-done strategy, of which 89.6% (1,459/1,628) were discharged from the ED and 0.2% (3/1,628) had all-cause mortality or myocardial infarction at 30 days. Thus, the one-and-done strategy was safe and effective.
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Ashburn et al. (2026) conducted a cohort in Acute chest pain (n=12,190). High-sensitivity HEART Pathway one-and-done troponin strategy was evaluated on All-cause mortality or myocardial infarction.
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