High-Sensitivity HEART Pathway One-and-Done Troponin Strategy is Safe and Effective

The high-sensitivity History, Electrocardiogram (ECG), Age, Risk factor, and Troponin (HEART) Pathway (hs-HP) includes a "one-and-done" strategy where patients with a non-ischemic ECG, no known coronary artery disease, HEAR score ≤3, and chest pain duration >3 hours can be discharged with a single very-low high-sensitivity troponin (hs-cTnI) measure <4 ng/L. We aimed to evaluate the safety and effectiveness of this "one-and-done" hs-cTn strategy using a multisite emergency department cohort of patients with acute chest pain (N=12,190). Among these, 13.4% (1,628/12,190) were eligible for the one-and-done strategy, of which 89.6% (1,459/1,628) were discharged from the ED and 0.2% (3/1,628) had all-cause mortality or myocardial infarction at 30 days. Thus, the one-and-done strategy was safe and effective.