High-Sensitivity Troponin Testing: The End of Unnecessary Chest Pain Admissions?

High-Sensitivity Troponin Testing: The End of Unnecessary Chest Pain Admissions?

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Introduction

The introduction of high-sensitivity cardiac troponin (hs-cTn) assays has fundamentally transformed the evaluation and management of patients presenting with chest pain in the emergency department (ED). Troponin testing has long been a cornerstone of acute coronary syndrome (ACS) assessment, but the transition from conventional to high-sensitivity assays represents a major advancement in diagnostic accuracy, workflow efficiency, and patient outcomes.

Evidence from studies involving more than 32,000 emergency department visits demonstrates that the use of high-sensitivity cardiac troponin I (hs-cTnI) testing is associated with a significant reduction in hospital admissions. Implementation of hs-cTnI resulted in an absolute decrease of 5.6% in admissions compared with traditional troponin assays, which translates to approximately five fewer chest pain admissions per week across just three emergency departments. These findings underscore the potential of hs-cTn testing to alleviate overcrowding in emergency departments while maintaining diagnostic precision and patient safety.

Operational efficiency has also improved with the adoption of high-sensitivity assays. Emergency departments using hs-cTn have reported shorter median lengths of stay—6.0 hours compared with 6.6 hours using conventional assays—and higher discharge rates (87.5% versus 85.3%). These improvements reflect the ability of hs-cTn to accelerate clinical decision-making, facilitate earlier rule-out or rule-in of myocardial injury, and optimize patient flow through the emergency care pathway.

The 2021 American Heart Association (AHA) and American College of Cardiology (ACC) guidelines for the evaluation and diagnosis of acute chest pain formally recognize high-sensitivity troponin as the preferred biomarker for assessing myocardial injury. Since 2017, multiple hs-cTn assays have received clearance from the U.S. Food and Drug Administration, leading to widespread clinical adoption and the establishment of standardized algorithms for risk stratification. These algorithms, often integrating 0/1-hour or 0/2-hour testing protocols, allow clinicians to rapidly identify patients at low risk for acute myocardial infarction who can be safely discharged, as well as those requiring urgent intervention.

Beyond operational and diagnostic benefits, the analytical superiority of hs-cTn assays provides greater sensitivity for detecting minimal levels of cardiac injury. This enables earlier identification of myocardial infarction and improved differentiation between ischemic and non-ischemic causes of troponin elevation. When interpreted within appropriate clinical and temporal contexts, hs-cTn results enhance diagnostic confidence and reduce the reliance on serial testing or unnecessary hospital admissions.

This review explores how high-sensitivity troponin testing is redefining the evaluation of chest pain in modern emergency medicine. It examines the analytical advantages of hs-cTn over conventional assays, the evidence supporting its impact on patient outcomes and resource utilization, and the strategies for effective implementation within diverse healthcare systems. Emerging data suggest that hs-cTn algorithms may mark a turning point in acute care—one where unnecessary chest pain admissions are minimized without compromising safety or diagnostic accuracy. For clinicians and health system leaders alike, understanding and optimizing the use of hs-cTn testing is essential to advancing both patient care and operational efficiency in emergency medicine.

Keywords: high-sensitivity troponin, chest pain, acute coronary syndrome, emergency department, diagnostic algorithm, clinical outcomes

Overview

Low MI prevalence in ED chest pain cases

Chest pain represents a significant proportion of emergency department visits, accounting for approximately 5.5% of all ED visits in the United States, totaling nearly 11 million encounters annually. Nevertheless, the actual prevalence of acute myocardial infarction among these patients is remarkably low. Studies demonstrate that merely 4% of patients presenting with chest pain are ultimately diagnosed with MI. This low prevalence creates a fundamental diagnostic dilemma.

A comprehensive retrospective cohort study examining 8,711 ED visits for non-traumatic chest pain found that 37.6% resulted in hospitalization. Among those hospitalized, only 10.7% (representing just 3.8% of all chest pain visits) had acute myocardial infarction. Moreover, in 29.4% of these hospitalizations, myocardial infarction was ‘ruled out’ with no cardiac ischemia or other serious etiology for the chest pain identified.

Despite this low prevalence, the risk of missing cases remains a persistent concern. Previous studies have found that between 2-8% of patients with acute myocardial infarction who present to emergency departments are sent home. Given that approximately half of the 1.1 million annual MI patients come to emergency departments, this represents at least 11,000 missed diagnoses per year.

Overuse of conventional troponin testing

The fear of missed diagnosis has consequently led to defensive medicine practices and overuse of conventional troponin testing. A survey of emergency department physicians revealed that 38.3% admitted to ordering troponin tests in non-cardiac patients primarily due to medicolegal concerns. Furthermore, 53% reported working under medicolegal pressure, and 50% believed they would order fewer troponin tests if not for this medicolegal threat.

Traditional cardiac troponin testing, although valuable, often results in resource-intensive evaluation pathways. The total cost of chest pain testing in the United States ranges from $10-13 billion annually. This cost stems partly from the limitations of conventional troponin assays, which may require longer observation periods and serial testing to detect changes in troponin levels.

Clinical assessment based on history, physical examination, and initial diagnostic tools like electrocardiogram or conventional cardiac biomarkers cannot reliably rule in or exclude acute coronary syndromes. Therefore, clinicians frequently overutilize resources for patients with chest pain, resulting in unnecessary hospitalizations, billions in avoidable costs, and potential iatrogenic harm without clinical benefits.

Impact of false positives on hospital admissions

False positive troponin results present an under-recognized phenomenon that can lead to unnecessary hospitalization, testing, and downstream consequences. Several factors contribute to false positive results, including:

• Non-ischemic causes of troponin elevation such as renal dysfunction, pulmonary embolism, and sepsis
• Analytical interferences from heterophile antibodies or rheumatoid factors
• Persistent and static troponin elevation inconsistent with acute coronary syndrome

The literature suggests that the frequency of false positives with conventional troponin I assays ranges from 0.5-3%. However, one study found a false positive rate of 9.5% when comparing high-sensitivity troponin T with troponin I in unselected emergency department patients.

The consequences of false positive results extend beyond immediate care decisions. For patients with assay interference, troponin levels remain persistently elevated, potentially triggering repeated rounds of investigation. This situation can lead to misdiagnosis of myocardial injury, unnecessary hospital admission, patient anxiety, and inappropriate medical treatment or invasive procedures.

In fact, a multicenter study found that 79% of elevated troponin levels were associated with diagnoses other than acute myocardial infarction. This highlights the challenge of interpreting troponin results in isolation without proper clinical context.

The introduction of high-sensitivity cardiac troponin assays provides an opportunity to address many of these diagnostic challenges through improved sensitivity, negative predictive value, and shorter time intervals between measurements. This advancement may help reduce unnecessary admissions while maintaining safety in chest pain evaluation.

 

What Is High-Sensitivity Troponin and How It Works

Troponin testing has evolved considerably over the past two decades, with high-sensitivity cardiac troponin (hs-cTn) assays now representing the standard method for troponin measurement in clinical laboratories. These advanced assays have transformed the detection capabilities for myocardial injury and significantly altered diagnosis and management pathways for patients with suspected acute coronary syndrome.

Definition and analytical sensitivity of hs troponin

Cardiac troponins are structural proteins found within the troponin complex of cardiac muscle thin filaments. The complex consists of three subunits—troponin I, T, and C—that play crucial roles in muscle contraction regulation. Though troponin C appears in both skeletal and cardiac muscles, troponin I and T exist primarily in the myocardium, hence their designation as cardiac troponins (cTnI and cTnT).

High-sensitivity cardiac troponin assays must meet specific analytical criteria established by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Committee on Clinical Applications of Cardiac Biomarkers. These requirements include:

1. Imprecision of less than 10% at the 99th percentile upper reference limit
2. Ability to measure troponin in at least 50% of males and 50% of females above the limit of detection within a normal healthy cohort

Rather than detecting a novel form of troponin, high-sensitivity assays represent methodological improvements that allow detection at very low concentrations with minimal analytical imprecision. The enhanced analytical performance enables the measurement of troponin values well below the 99th percentile upper reference limit, ultimately permitting the quantification of troponin in most healthy individuals.

First introduced to clinical practice in 2007, high-sensitivity troponin assays received FDA approval for use in the United States in 2017. Currently, multiple hs-cTnI assays and one hs-cTnT assay are available, each with different analytical characteristics.

Sex-specific 99th percentile thresholds

One of the most notable attributes of high-sensitivity troponin assays is their ability to identify sex-based differences in troponin levels. Men consistently demonstrate higher 99th percentiles than women across all hs-cTn assays. This difference likely stems from men’s larger left ventricular mass and higher prevalence of subclinical cardiovascular disease in apparently healthy reference populations.

For hs-cTnI assays, sex-specific 99th percentile upper reference limits vary by manufacturer but typically range from 16-34 ng/L for women and 34-53 ng/L for men. The Abbott ARCHITECT STAT high-sensitive troponin I assay, for instance, employs sex-specific thresholds of 16 ng/L for women and 34 ng/L for men.

Though not universally implemented worldwide, sex-specific thresholds have received endorsement from multiple guideline groups, including the Fourth Universal Definition of Myocardial Infarction. Furthermore, all FDA-cleared hs-cTn assays now report sex-specific 99th percentiles. These sex-specific thresholds help address potential underdiagnosis of myocardial infarction in women, who traditionally present with lower troponin values yet may have equally serious cardiac conditions.

Comparison with conventional cTn assays

High-sensitivity assays offer several fundamental advantages over conventional troponin testing. Conventional (fourth-generation) troponin assays typically detect levels starting around 29 ng/L, whereas hs-cTn assays can detect levels as low as 3-5 ng/L. This dramatic improvement in detection capability transforms the diagnostic timeline for suspected myocardial infarction.

Unlike conventional assays that may require 6-12 hours to reach adequate sensitivity, high-sensitivity troponin crosses its detection limit rapidly, allowing earlier identification of myocardial injury. This enhanced analytical sensitivity enables the development of rapid rule-out protocols using baseline measurements or short intervals between testing (0/1h or 0/2h algorithms).

Beyond improved sensitivity, hs-cTn assays demonstrate superior negative predictive value, facilitating earlier exclusion of myocardial infarction. Nevertheless, this enhanced sensitivity comes with challenges—primarily the detection of previously unrecognized myocardial injury from non-ACS conditions. Accordingly, proper interpretation requires distinguishing acute from chronic injury patterns through serial measurements and assessment of troponin concentration changes over time.

For reporting purposes, hs-cTn concentrations should be expressed in ng/L units (rather than ng/mL or μg/L) and rounded to whole numbers without decimals to avoid potential interpretation errors.

 

Implementation of High-Sensitivity Troponin Protocols

Despite compelling evidence supporting their clinical benefits, the adoption of high-sensitivity troponin assays in American hospitals has followed a distinctly different trajectory compared to their international counterparts. The implementation of these advanced testing protocols presents both opportunities and challenges for emergency departments seeking to optimize chest pain evaluation pathways.

Adoption of hs-cTnI in US hospitals

The utilization of high-sensitivity cardiac troponin assays in the United States has expanded gradually following FDA approval in 2017—markedly later than many other countries where approval occurred as early as 2010. Initially, implementation rates remained modest, with only 3.3% of hospitals using hs-cTn in early 2019. Subsequently, adoption increased to 32.6% by the third quarter of 2021. Yet even with this growth, approximately two-thirds (66%) of U.S. hospitals had not implemented high-sensitivity troponin testing by September 2021.

Several factors contribute to this delayed adoption pattern. First, concerns persisted that implementing hs-cTn would increase admission rates and downstream cardiac testing for low-risk patients. Second, the benefits demonstrated in international trials may not translate directly to U.S. practice patterns, which often involve more testing of low-risk patients due to higher cardiovascular comorbidity prevalence and medicolegal considerations.

Notably, professional society guidelines have now fully embraced high-sensitivity troponin as the preferred standard. In October 2021, the American Heart Association and American College of Cardiology published joint guidelines making a class I recommendation that hs-cTn is the preferred biomarker for evaluating acute chest pain.

Use of 0/1h and 0/2h high sensitivity troponin algorithm

The implementation of hs-cTn protocols typically incorporates rapid diagnostic algorithms based on serial sampling within the first few hours after presentation. The European Society of Cardiology (ESC) has developed several validated approaches:

• 0h/1h algorithm: Utilizes troponin measurements at presentation and after 1 hour. This approach achieves accurate early triage in approximately 75% of patients—60% toward rule-out and 15% toward rule-in of myocardial infarction.
• 0h/2h algorithm: Follows identical conceptual framework as the 0h/1h approach but draws the second sample after 2 hours with different cutoff values.
• 0h/3h algorithm: The original ESC algorithm introduced in 2011, now considered an alternative to the faster protocols.

These strategies operate on two fundamental principles: higher hs-cTn concentrations correspond to greater probability of myocardial infarction, and absolute changes in concentrations within 1-2 hours can effectively substitute for changes observed over longer intervals.

Integration with clinical decision support tools

Successful implementation of hs-cTn protocols often requires robust clinical decision support (CDS) tools. Electronic health record integration of accelerated diagnostic protocols has demonstrated measurable benefits in real-world settings. For instance, one health system introduced an Emergency Department Acute Coronary Syndrome workflow pathway utilizing sex-specific 99th percentile upper reference limits (>17 ng/L for women and >35 ng/L for men).

Correspondingly, institutions have developed various approaches to facilitate appropriate implementation:

1. EHR-integrated order panels that provide automated reflex testing based on initial results
2. Interactive flow diagrams within electronic health records that synthesize guidelines with local expert consensus
3. Clinical pathways incorporating risk stratification tools like the HEART score alongside hs-cTn algorithms

The High-Sensitivity HEART Pathway (hs-HP), which combines the HEAR score with 0- and 2-hour serial hs-cTnI measures, has demonstrated impressive outcomes when implemented across multiple emergency departments. In one study, this approach decreased 30-day hospitalizations from 47.5% to 31.4%, representing an absolute reduction of 16.1%. Simultaneously, early discharges increased by 19.9% following implementation.

This integrated approach exemplifies how U.S. health systems can effectively combine hs-cTn with other clinically relevant variables to provide safe, high-value care to millions of chest pain patients annually.

 

Operational Impact on Emergency Department Metrics

The implementation of high sensitivity troponin (hs-cTn) testing creates measurable effects on emergency department operations across multiple health systems. Recent data demonstrates substantial improvements in patient flow metrics, resource utilization, and hospital capacity management following hs-cTn adoption.

Reduction in total hospital length of stay (LOS)

Multiple studies confirm that high-sensitivity troponin implementation shortens total hospital stays for chest pain patients. A comprehensive analysis of 32,076 ED visits revealed that median total LOS decreased from 6.6 hours to 6.0 hours after transitioning to hs-cTnI. This 0.6-hour reduction, while seemingly modest, creates substantial cumulative capacity—estimated to support approximately 1,600 additional ED visits annually based on one system’s volume.

Even greater benefits emerge in certain populations. For patients directly discharged to home, the median ED LOS dropped from 6.2 hours to 5.3 hours (a 47-minute reduction) after introducing hs-cTn. For admitted patients, the improvement was even more pronounced, with median ED LOS decreasing from 9.5 hours to 8.1 hours (a 77-minute reduction).

Specifically, another study examining high-sensitivity troponin T (hs-cTnT) implementation documented a remarkable 269.7-minute reduction in hospital LOS, representing an 11% relative decrease (OR=0.89, 95% CI 0.84-0.94). This effect persisted even after researchers adjusted for patient comorbidities and characteristics.

ED door-to-disposition time changes

Interestingly, door-to-disposition times show mixed effects after hs-cTn implementation. Overall, hospitals typically experience a small but noteworthy increase in this metric. One multi-site study observed ED door-to-disposition time extending from 3.8 hours to 3.9 hours after hs-cTnI adoption. This slight elongation of decision-making time may reflect the implementation of 1-hour intervals between serial troponin testing, compared with the 3-to-6-hour intervals previously used with conventional assays.

Other research supports this pattern. A single-center study found median ED LOS was longer after hs-cTn implementation (384 minutes versus 374 minutes), with an adjusted geometric mean ratio of 1.05. This paradoxical finding—longer door-to-disposition but shorter overall LOS—suggests that while initial decision-making may take marginally longer, the entire care episode becomes more efficient.

Particularly worth noting is how hs-cTn changes troponin testing patterns. After implementation, the total number of troponin tests often declines by over 10%, with substantial reductions in 3- and 4-sample collections (-61% and -73% respectively). Furthermore, approximately 27.5% of patients display hs-cTnI values below the limit of detection at admission, enabling safe, early discharge.

Admission vs discharge rate shifts

Hospital admission rates consistently decline following hs-cTn implementation. A large analysis of 26,126 patients demonstrated that 30-day hospitalization rates fell from 47.5% to 31.4% after introducing high-sensitivity protocols—an absolute decrease of 16.1% (95% CI, 14.9-17.3) with an odds ratio of 0.51.

This pattern appears throughout multiple studies with different magnitudes:

• 38.2% to 32.6% reduction in admissions (aOR 0.74, 95% CI 0.69-0.79)
• 28% to 24% reduction (aOR 0.75, 95% CI 0.64-0.88)
• 42.5% to 36.8% decrease in hospital admissions

Concurrently, early discharge rates increase substantially. One study reported early discharge rates rising from 43.7% to 63.6% following hs-cTn implementation (OR 2.25, 95% CI 2.14-2.36). Similarly, direct ED discharge rates increased from 39.0% to 45.2% in another health system.

The real-world impact of these shifts proves substantial. A 5.6% absolute reduction in admissions translated to approximately five fewer admissions for chest pain per week across three emergency departments in one health system. For facilities struggling with ED crowding and hospital capacity constraints, these operational improvements represent meaningful benefits of high-sensitivity troponin algorithms beyond their clinical advantages.

 

Downstream Testing and Resource Utilization

The transition to high-sensitivity troponin (hs-cTn) testing fundamentally alters downstream resource utilization patterns, creating a more focused approach to cardiac testing after initial evaluation.

Decrease in echocardiograms and stress tests

Implementation of hs-cTn protocols typically results in fewer cardiac diagnostic tests overall. After introducing hs-cTn, one health system reported 23.5 cardiac tests per 100 patient visits compared to 27.8 tests per 100 visits during the conventional troponin era. This pattern emerges consistently across multiple studies, with one large cohort demonstrating fewer orders for echocardiograms (−2.8 per 100 patient visits) and stress tests (−1.9 per 100 patient visits) following hs-cTn adoption.

The reduction in stress testing appears especially pronounced. One center observed a decrease from 1,026 to 742 stress tests after implementing hs-cTn. Soon after high-sensitivity troponin introduction, stress testing rates fell from 6.5% to 4.9% of ED chest pain encounters, representing substantial resource conservation.

Increased use of CCTA and PCI

In contrast to declining stress test and echocardiogram usage, coronary computed tomography angiography (CCTA) utilization generally increases after hs-cTn implementation. During one large-scale rollout, CCTA utilization rose by 0.23 per 100 patient visits (adjusted odds ratio 1.26). This shift likely reflects growing provider confidence in CCTA’s anatomic assessment capabilities compared to functional testing.

Percutaneous coronary intervention (PCI) rates likewise increase following hs-cTn adoption. One multicenter study found PCI rates increased by 0.66 per 100 patient visits (adjusted odds ratio 1.40). This finding suggests that hs-cTn may enable more precise identification of patients who truly benefit from invasive intervention.

Fewer cardiology consultations per 100 visits

Aside from changes in testing patterns, cardiology specialist involvement decreases as well. During routine operations, cardiology consultation rates typically decline by 1.2 consultations per 100 patient visits following hs-cTn implementation. This reduction translates to approximately 2.8 fewer cardiology consultations weekly across a three-hospital system.

The diagnostic yield—or ratio of positive tests to total tests—remains relatively stable despite fewer total tests. One study found the yield was nearly identical before and after implementation (22.2% versus 21.8%), demonstrating that reducing testing volume did not compromise diagnostic accuracy. Thus, hs-cTn appears to enable more targeted resource utilization without sacrificing clinical effectiveness.

 

Safety Outcomes and Follow-Up Considerations

Patient safety remains the paramount concern when implementing accelerated diagnostic protocols with high sensitivity troponin. Extensive data now confirms these protocols maintain excellent safety profiles.

30-day MACE and ED revisit rates

Adoption of hs-cTn protocols yields comparable safety outcomes to conventional testing. The 30-day major adverse cardiac event (MACE) rates remain stable following implementation (13.6% vs 13.1%). For patients classified as low-risk with normal hs-troponin values, the 30-day MACE rate stays remarkably low at 0.34%. Even more impressive, patients with index hs-troponin below the limit of quantification demonstrate just 0.19% 30-day MACE rates. ED revisit rates at 72 hours likewise show no increase (3.7% versus 3.7%).

Outpatient follow-up within 2 weeks

Current guidelines emphasize outpatient follow-up for low-risk patients. The AHA/ACC guidelines primarily recommend expedited outpatient evaluation rather than admission for patients with recurrent, low-risk chest pain. Essentially, this strategy includes early cardiology assessment within two weeks, particularly for patients whose risk scores indicate low but not negligible risk.

Avoiding missed diagnoses with hs-cTn

The HEART score remains valuable for risk stratification, with a low score (<3) predicting 30-day MACE miss rates of 0-2%. Still, clinical context matters—patients with known coronary artery disease require careful consideration, as their negative predictive value falls to 96.6% versus 98.9% in those without coronary disease.

 

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Conclusion

High-sensitivity cardiac troponin testing has transformed emergency department management of chest pain patients. Evidence demonstrates substantial operational benefits across multiple health systems, including reduced hospital admissions by 5.6% absolute reduction, shorter total length of stay, and increased early discharge rates. These improvements occur without compromising patient safety, as 30-day MACE rates remain stable while ED revisit rates show no increase following implementation.

Healthcare systems adopting hs-cTn protocols experience measurable changes in downstream resource utilization. Notable reductions in stress testing and echocardiograms accompany modest increases in CCTA and PCI rates, suggesting more targeted resource allocation rather than indiscriminate testing. Though door-to-disposition times may increase slightly with rapid serial testing protocols, overall hospital stays shorten meaningfully, creating additional capacity throughout the emergency care system.

Despite FDA approval in 2017 and strong endorsement from professional organizations, adoption of high-sensitivity troponin remains incomplete across American hospitals. Clinical decision support tools like the High-Sensitivity HEART Pathway help bridge this implementation gap, combining risk stratification with serial hs-cTn measurements to safely identify low-risk patients appropriate for early discharge.

Sex-specific thresholds represent another advancement, addressing potential underdiagnosis of myocardial infarction in women who traditionally present with lower troponin values. The analytical sensitivity of modern assays enables detection of previously unmeasurable troponin levels, allowing clinicians to distinguish between acute and chronic patterns through serial measurements.

Therefore, high-sensitivity troponin testing appears to fulfill its promise of reducing unnecessary chest pain admissions while maintaining excellent safety profiles. After years of defensive practices driven by medicolegal concerns and limitations of conventional assays, emergency departments now possess the tools needed to provide appropriate, risk-stratified care for the millions of patients presenting with chest pain annually. Though complete implementation requires careful protocol development and educational initiatives, the evidence overwhelmingly supports continued adoption of high-sensitivity troponin testing as standard practice for modern emergency departments.

Key Takeaways

High-sensitivity troponin testing is revolutionizing emergency department chest pain management, offering a pathway to reduce unnecessary hospitalizations while maintaining patient safety standards.

• Dramatic admission reduction: hs-cTn implementation reduces hospital admissions by 5.6% absolute reduction, translating to approximately 5 fewer chest pain admissions per week across emergency departments.
• Enhanced operational efficiency: Median total hospital length of stay decreases from 6.6 to 6.0 hours, while early discharge rates increase from 43.7% to 63.6%.
• Maintained safety profile: 30-day major adverse cardiac events remain stable (13.6% vs 13.1%) with remarkably low MACE rates of 0.34% for low-risk patients.
• Optimized resource utilization: Stress testing and echocardiogram usage decline by 23-28%, while more targeted use of CCTA and PCI increases appropriately.
• Sex-specific precision: Implementation of sex-specific thresholds (16 ng/L for women, 34 ng/L for men) addresses potential underdiagnosis of myocardial infarction in women.

The evidence strongly supports widespread adoption of high-sensitivity troponin protocols as the new standard for emergency chest pain evaluation, ending the era of defensive medicine practices that led to unnecessary admissions.

 

 

Frequently Asked Questions:

FAQs

Q1. What is high-sensitivity troponin testing and how does it differ from conventional tests? High-sensitivity troponin (hs-cTn) tests are advanced assays that can detect very low levels of cardiac troponin with high precision. Unlike conventional tests, hs-cTn can measure troponin in most healthy individuals and detect changes in troponin levels much earlier, allowing for faster diagnosis of heart attacks.

Q2. How does high-sensitivity troponin testing impact hospital admissions for chest pain? Studies show that implementing hs-cTn testing reduces hospital admissions for chest pain by about 5.6%. This translates to approximately 5 fewer chest pain admissions per week across emergency departments, significantly decreasing unnecessary hospitalizations.

Q3. Are there any safety concerns with using high-sensitivity troponin protocols? Research indicates that high-sensitivity troponin protocols maintain excellent safety profiles. The 30-day major adverse cardiac event (MACE) rates remain stable after implementation, and there is no increase in emergency department revisit rates within 72 hours.

Q4. How does high-sensitivity troponin testing affect emergency department operations? Hs-cTn testing improves operational efficiency in emergency departments. It reduces the median total hospital length of stay from 6.6 to 6.0 hours and increases early discharge rates from 43.7% to 63.6%. This leads to better patient flow and resource utilization.

Q5. Why are sex-specific thresholds important in high-sensitivity troponin testing? Sex-specific thresholds (e.g., 16 ng/L for women, 34 ng/L for men) are crucial because they address potential underdiagnosis of myocardial infarction in women. Women typically present with lower troponin values, and using sex-specific thresholds helps ensure more accurate diagnoses across genders.

 

 

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