Introduction of High-Sensitivity Troponin Assay to Rural Tertiary Care Medical Center: Impact on Subsequent Cardiac...

High-sensitivity cardiac troponin (hs-cTn) assay offers improved diagnostic accuracy for the detection of myocardial infarction but has seen slow adoption in the United States, particularly in rural settings. Limited research has explored the impact of hs-cTn implementation on downstream testing, in rural hospitals where diagnostic delays are common. This study evaluates the effects of transitioning from standard assay to hs-cTn in a rural tertiary care medical center. We conducted a retrospective analysis of de-identified data from four weeks before and after the implementation of an hs-cTn assay. We assessed the presence of downstream cardiovascular testing and consults among emergency department and inpatient chest pain encounters. Lengths of stay were evaluated. In total, 1664 pre- and 1479 post-implementation admissions were evaluated. Demographic characteristics and comorbidities were similar during the study period. Chest pain was reported more frequently during the post-hs-cTn implementation period as the chief complaint (21.4% vs. 28.7%; p = 0.0036). There was a statistically significant decrease in the number of downstream stress tests performed in the second period (aOR 0.55, 95% CI: 0.31-0.98). The adjusted odds ratio (aOR) for cardiac catheterization trended toward a non-significant decrease (aOR 0.57, 95% CI: 0.40-1.11). Lengths of stay were similar between groups. In a retrospective analysis of patients who underwent cardiac troponin assays, we found that the implementation of hs-cTn was associated with a decrease in downstream stress testing without a significant increase in the number of cardiology consultations, coronary angiographies, or coronary computed tomography scans.