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Implementation of High-Sensitivity Cardiac Troponin Assays in the United States
Cian McCarthy1, Shuang Li2, Tracy Y Wang3
1Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Insights
High-sensitivity cardiac troponin (hs-cTn) assay use is increasing in US hospitals, associated with shorter hospital stays and changes in cardiac testing. Most hospitals still use less sensitive assays, highlighting ongoing implementation gaps.
Area of Science:
- Cardiology
- Clinical Diagnostics
- Health Services Research
Background:
- Limited data exist on the adoption of high-sensitivity cardiac troponin (hs-cTn) assays in the United States following their approval.
- Understanding the implementation trends and impact of these sensitive assays is crucial for improving cardiac care.
Purpose of the Study:
- To investigate the trends in hs-cTn assay implementation across US hospitals.
- To evaluate the association between hs-cTn use and in-hospital cardiac testing strategies and patient outcomes.
Main Methods:
- Analysis of data from 550 hospitals in the National Cardiovascular Data Registry Chest Pain-MI Registry (2019-2021).
- Examination of hs-cTn implementation rates over time.
- Statistical modeling (generalized estimating equations) to assess associations between hs-cTn use, diagnostic testing, and outcomes.
Main Results:
- hs-cTn assay implementation rose from 3.3% to 32.6% of hospitals between Q1 2019 and Q3 2021.
- hs-cTn use correlated with increased echocardiography for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and decreased invasive angiography in low-risk patients.
- A modest reduction in length of hospital stay was observed with hs-cTn use; no significant impact on mortality or revascularization for NSTE-ACS patients.
Conclusions:
- hs-cTn assay adoption is growing in US hospitals, though widespread use is not yet achieved.
- hs-cTn implementation is linked to specific changes in diagnostic testing patterns and a shorter hospital length of stay.
- Further research may be needed to optimize hs-cTn use and its full clinical and economic impact.
Background:
Few data exist regarding the implementation of high-sensitivity cardiac troponin (hs-cTn) assays in the United States since their approval.
Objectives:
This study sought to explore trends in hs-cTn assay implementation over time and assess the association of their use with in-hospital cardiac testing and outcomes.
Methods:
The study examined trends in implementation of hs-cTn assays among participating hospitals in the National Cardiovascular Data Registry Chest Pain-MI [Myocardial Infarction] Registry from January 1, 2019 through September 30, 2021. Associations among hs-cTn use, use of in-hospital diagnostic imaging, and patient outcomes were assessed using generalized estimating equation models with logistic or gamma distributions.
Results:
Among 550 participating hospitals (N = 251,000), implementation of hs-cTn assays increased from 3.3% in the first quarter of 2019 to 32.6% in the third quarter of 2021 (Ptrend < 0.001). Use of hs-cTn was associated with more echocardiography among persons with non-ST-segment elevation acute coronary syndrome (NSTE-ACS; 82.4% vs 75.0%; adjusted odds ratio: 1.43; 95% CI: 1.19-1.73) but not among low-risk chest pain individuals. Use of hs-cTn was associated with less invasive coronary angiography among low-risk patients (3.7% vs 4.5%; adjusted odds ratio: 0.73; 95% CI: 0.58-0.92) but similar use for patients with NSTE-ACS. There was no association between hs-cTn use and noninvasive stress testing or coronary computed tomography angiography testing. Among individuals with NSTE-ACS, hs-cTn use was not associated with revascularization or in-hospital mortality. Use of hs-cTn was associated with a shorter length of stay (median 47.6 hours vs 48.0 hours; ratio: 0.94; 95% CI: 0.90-0.98).
Conclusions:
Implementation of hs-cTn among U.S. hospitals is increasing, but most U.S. hospitals continue to use less sensitive assays. The use of hs-cTn was associated with modestly shorter length of stay, greater use of echocardiography for NSTE-ACS, and less use of invasive angiography among low-risk patients.
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