Safety of Using Risk Stratification Along With High-Sensitivity Cardiac Troponin in the Emergency Department: A...

Area of Science:

• Cardiology
• Emergency Medicine
• Diagnostic Testing

Background:

• Early rule-out pathways for myocardial infarction using high-sensitivity cardiac troponin (hs-cTn) decrease hospital stay and admissions.
• Uncertainty exists regarding the effectiveness of hs-cTn in low-to-intermediate risk patients and the long-term safety of discharged individuals.

Purpose of the Study:

• To evaluate the effectiveness and safety of hs-cTn risk stratification in patients with suspected acute coronary syndrome (ACS) deemed low and intermediate risk.

Main Methods:

• Secondary analysis of a stepped-wedge cluster-randomized controlled trial involving 31,492 patients with suspected ACS.
• Patients were stratified as low (<5 ng/L) or intermediate (5 ng/L to 99th percentile) risk using hs-cTn.
• Primary outcomes were length of hospital stay (effectiveness) and subsequent myocardial infarction or cardiac death at 1 year (safety).

Main Results:

• Hs-cTn implementation reduced length of stay in both low-risk (2.2 hours) and intermediate-risk (4.8 hours) patients (P < 0.001).
• Emergency department discharge rates increased significantly in low-risk (adjusted OR: 3.31) and intermediate-risk (adjusted OR: 2.06) patients.
• Discharged patients had a lower 1-year risk of myocardial infarction or cardiac death (aHR: 0.65), irrespective of initial risk stratification.

Conclusions:

• Risk stratification with hs-cTn is effective in reducing hospital stay and increasing emergency department discharges for low- and intermediate-risk ACS patients.
• Patients discharged following hs-cTn risk stratification exhibit a reduced risk of subsequent major adverse cardiac events at one year.