The following is a summary of “Frequency, compliance, and yield of cardiac testing after high-sensitivity troponin accelerated diagnostic protocol implementation,” published in the October 2023 issue of Emergency Medicine by Baugh, et al.

In the evaluation of individuals presenting to the emergency department with suspected acute myocardial infarction (MI), cardiac troponin (cTn) testing is a common practice for detecting acute myocardial injury. Accelerated diagnostic protocols (ADPs) assist clinicians in integrating cTn results with other clinical information to decide further diagnostic testing. For a study, researchers sought to assess the changes in the rate and yield of stress tests or coronary CT angiograms following cTn measurement in patients with chest pain presenting to the emergency department before and after transitioning to a high-sensitivity (hs-cTn) assay in an updated ADP.

Utilizing electronic health records, chest pain visits at five emergency departments affiliated with an integrated academic health system were examined over a 1-year pre- and post-hs-cTn assay transition period. Outcomes included the frequency of stress tests or coronary imaging, ADP compliance among those undergoing additional testing, and diagnostic yield (ratio of positive tests to total tests).

A total of 7,564 patient visits for chest pain were included, with 3,665 in the pre-hs-cTn and 3,899 in the post-hs-cTn period. Following the updated ADP using hs-cTn, 23.5 visits per 100 patients led to subsequent testing compared to 27.8 visits per 100 patients in the pre-hs-cTn period (P < 0.001). Among those tested, the protocol-compliant rate decreased from 80.9% to 46.5% (P < 0.001), while the yield of those tests increased from 24.5% to 29.2% (P = 0.07). Among tests noncompliant with ADP guidance, the yield was similar to pre- and post-updated hs-cTn ADP implementation (pre 13.0%, post 15.4%, P = 0.43).

The implementation of hs-cTn supported by an updated ADP was associated with a lower rate of stress testing and coronary CT angiograms.

Source: sciencedirect.com/science/article/abs/pii/S0735675723003686