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The following is a summary of “Effect of transitioning from conventional cardiac troponin to high-sensitivity cardiac troponin on resource utilization- a single center experience,” published in the June 2024 issue of Emergency Medicine by Koirala, et al.
The high-sensitivity cardiac troponin (hs-cTn) assay offered improved detection of myocardial infarction (MI) compared to conventional cardiac troponin (cTn).
A descriptive retrospective analysis was conducted to evaluate resource utilization at Rush University Medical Center during the transition period from cTn to hs-cTn assay (July 1, 2021). The study included emergency department (ED) encounters from January 1 to December 31, 2021, with chief complaints of “chest pain” or “dyspnea” and associated troponin orders.
The primary endpoint was the percentage of ED discharges. Secondary endpoints included the number of cardiac studies ordered. Univariable comparisons were performed using Student’s t-test for continuous variables and Chi-square tests for binary/categorical variables.
About 5,113 encounters were analyzed. Using hs-cTn was associated with increased patients in ED discharges with negative troponin tests (44.1% vs. 29.9%, P < 0.01). The hs-cTn period saw significant increases in the number of troponin tests per encounter (1.9 vs. 1.6, P < 0.01), electrocardiograms (3.0 vs. 2.9, P = 0.01), and echocardiograms (0.5 vs. 0.4, P < 0.01). Conversely, there was a significant decrease in the utilization of stress testing (0.21 vs. 0.26, P < 0.01). There was also an increase in total coronary angiography use during the hs-cTn period compared to the cTn period (9.2% vs. 7.4%, P = 0.02).
The study concluded that transitioning from cTn to hs-cTn significantly increased ED discharges and the number of troponin tests, electrocardiograms, echocardiograms, and coronary angiograms performed. In contrast, the number of stress tests decreased.
Reference: sciencedirect.com/science/article/abs/pii/S0735675724001645
