A patient-centric chest pain management approach utilizing a high sensitivity Troponin-I assay

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Pathway Development

Background:

• Evaluating patients with chest pain in the emergency department (ED) requires efficient and accurate diagnostic tools.
• Traditional troponin assays and non-standardized approaches can lead to variable patient disposition and resource utilization.

Purpose of the Study:

• To assess the impact of adopting a new cardiac chest pain pathway incorporating high-sensitivity troponin I (hs-cTnI) testing in the ED.
• To evaluate the effect of this standardized pathway on patient disposition, length of stay, and clinical outcomes.

Main Methods:

• A retrospective observational study compared patients presenting with chest pain before and after the implementation of a new pathway.
• The new pathway included hs-cTnI testing (Seimens Healthineers Atellica) and risk stratification tools.
• Bivariate analyses compared outcomes, including discharge disposition, length of stay, and cardiac catheterization rates.

Main Results:

• The proportion of patients discharged from the ED increased, while observation or in-patient admissions decreased.
• Provider variation in patient disposition reduced, and stress testing rates for observed patients decreased.
• No significant change in 30-day Major Adverse Cardiac Events (MACE) was observed, but the 30-day Myocardial Infarction (MI) rate decreased.

Conclusions:

• The new standardized hs-cTnI algorithm approach is safe, with no increase in 30-day MACE.
• This pathway is more appropriate and efficient for evaluating chest pain patients in the ED compared to previous non-standardized methods.