Temporal Trends and Clinical Implications of Cardiac Troponin Testing in Emergency Departments: A Multicenter
Jong-Ho Kim1, Youngho Seo1, Seung Yong Shin2
1Korea University Research Institute for Medical Bigdata Science, Korea University, Seoul 02842, Republic of Korea.
Insights
Cardiac troponin testing is increasing in emergency departments, especially for low-risk patients. Targeted testing protocols can optimize resource use while maintaining diagnostic accuracy for acute coronary syndromes.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Cardiac troponin testing is crucial for diagnosing acute coronary syndromes.
- Increased troponin testing in low-risk emergency department (ED) populations may strain resources.
- Optimizing testing strategies is needed to balance diagnostic yield and resource utilization.
Purpose of the Study:
- To evaluate the impact of cardiac troponin testing trends on resource utilization and clinical outcomes in emergency departments.
- To assess the association between troponin testing, risk stratification, and patient outcomes in a real-world setting.
Main Methods:
- Multicenter retrospective cohort study (2017-2023) using harmonized electronic health records (OMOP-CDM, NEDIS).
- Stratified 727,772 ED visits into low, intermediate, and high risk based on age and chest pain presentation.
- Analyzed troponin T levels (normal, borderline, elevated) and outcomes including ED length of stay, admission, 30-day revisit, revascularization, and mortality.
Main Results:
- Troponin testing increased from 29.8% to 45.5% of visits, with significant rises in intermediate- and low-risk groups.
- In high-risk patients, normal troponin was linked to reduced 30-day revascularization and mortality without adverse effects on ED stay or admissions.
- In lower-risk groups, testing correlated with longer ED stays and higher admissions, lacking clear short-term clinical benefits.
Conclusions:
- Findings suggest that current troponin testing protocols may lead to overuse in lower-risk ED populations.
- Implementing targeted troponin testing strategies can enhance ED resource efficiency.
- Optimized protocols can maintain diagnostic performance for acute coronary syndromes in higher-risk patients.
Abstract:
Background: Cardiac troponin testing is central to evaluating suspected acute coronary syndromes, yet its expanding use may increase resource utilization in low-risk emergency department populations. Methods: We conducted a multicenter retrospective cohort study across three tertiary hospitals in South Korea (2017-2023) using harmonized electronic health record data integrated with the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM) and the National Emergency Department Information System (NEDIS). Visits were stratified into low, intermediate, and high risk by age and chest pain presentation, and cardiac troponin T was categorized as normal (<0.014 ng/mL), borderline (0.014-0.052 ng/mL), or elevated (>0.052 ng/mL). Outcomes included emergency department length of stay, hospital admission, 30-day revisit, 30-day coronary revascularization, and 30-day mortality. Results: Among 727,772 visits, troponin testing increased from 29.8% in 2017 to 45.5% in 2023. High-risk patients were consistently tested, whereas testing rose substantially in intermediate- and low-risk groups. In high-risk patients, normal troponin values were associated with lower 30-day revascularization and mortality, without prolonging length of stay or increasing admissions. In contrast, in lower-risk groups, testing was associated with longer stays and higher admissions without clear short-term clinical benefit. Conclusions: These findings support more targeted troponin testing protocols to optimize emergency department resource use while preserving diagnostic performance in higher-risk presentations.
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