The following is a summary of “Implementation of High-Sensitivity Cardiac Troponin Assays in the United States,” published in the 2023 January issue of Cardiology by McCarthy, et al.
Since their licensure, little information had been gathered about the use of high-sensitivity cardiac troponin (hs-cTn) tests in the US. For a study, researchers sought to examine historical trends in the usage of hs-cTn assays and to determine whether their use was related to outcomes and in-hospital cardiac testing.
The National Cardiovascular Data Registry Chest Pain-MI [Myocardial Infarction] Registry participating hospitals were studied to determine trends in the deployment of hs-cTn assays from January 1, 2019, to September 30, 2021. Generalized estimating equation models with logistic or gamma distributions were used to analyze the relationships between the usage of hs-cTn, in-hospital diagnostic imaging, and patient outcomes.
Implementation of hs-cTn tests grew among the 550 participating institutions (N = 251,000) from 3.3% in the first quarter of 2019 to 32.6% in the third quarter of 2021 (Ptrend <0.001). The use of hs-cTn was not linked with increased echocardiography in people with low-risk chest pain, but was among those with non-ST-segment elevation acute coronary syndrome (NSTE-ACS; 82.4% vs. 75.0%; adjusted odds ratio: 1.43; 95% CI: 1.19-1.73). For low-risk patients with NSTE-ACS, usage of hs-cTn was comparable but associated with less invasive coronary angiography (3.7% vs. 4.5%; adjusted odds ratio: 0.73; 95% CI: 0.58-0.92). The use of hs-cTn was not related to coronary computed tomography angiography or noninvasive stress testing. The use of hs-cTn among people with NSTE-ACS was not linked to revascularization or in-hospital mortality. The median length of stay was reduced when hs-cTn was used (47.6 hours vs. 48.0 hours; ratio: 0.94; 95% CI: 0.90-0.98).
Although more American hospitals were using hs-cTn, the majority still relied on less sensitive tests. In low-risk patients, the use of hs-cTn was linked to a marginally shorter duration of stay, increased use of echocardiography for NSTE-ACS, and decreased use of invasive angiography.