Clinical Impact of High-Sensitivity Cardiac Troponin-T Assays in the Community

ABSTRACT Background Limited United States (US) data exists on high-sensitivity cardiac troponin (hs-cTn) implementation. Objectives Evaluate the impact of hs-cTnT implementation. Methods Observational US cohort study of emergency department (ED) patients undergoing measurement of cTnT during the transition from 4th (pre-implementation 3/12/18-9/11/18) to 5th Gen cTnT (post-implementation 9/12/18-3/11/19)). Diagnoses were adjudicated following the 4th Universal Definition of Myocardial Infarction (MI). Resources evaluated included length of stay (LOS), hospitalizations, and cardiac testing. Results 3536 unique patients were evaluated, including 2069 and 2491 ED encounters pre- and post-implementation. Compared to 4th Gen cTnT, encounters with > 1 cTnT >99th percentile increased using 5th Gen cTnT (15% vs. 47%, p Conclusion Hs-cTnT implementation resulted in a marked increase in myocardial injury and MI, particularly in women and patients with type 2 MI. Despite this, except for angiography, overall resource use did not increase. Among those without cTnT increases, there were more ED discharges and fewer cardiac tests.