Implementation of High-Sensitivity Cardiac Troponin Assays in the United States

Clinical question: What are the trends in high sensitivity troponin (hs-cTn) assay use in the US and how is its use associated with clinical outcomes?

What was already known: Although hs-cTn assays have been shown to improve clinical outcomes in Europe and internationally, there is little data regarding the prevalence and clinical utility of hs-cTn assay use in the US.

Methods: This study examined trends in the implementation of hs-cTn in various hospitals in the US and assessed associations between hscTn use, use of in-hospital diagnostic imaging, and patient outcomes. The sample consisted of 550 hospitals and 251,000 patients, obtained from the National Cardiovascular Data Registry Chest Pain-MI Registry from January 1, 2019 – September 30, 2021.

Results/implications: Although the use of hs-cTn assays increased from 3.3% in early 2019 to 32.9% in late 2021 in the sample studied, over two-thirds of hospitals in the registry had not began implementing hs-cTn by September 2021. In the sample, this increase in hs-cTn use was found to be associated with increased use of echocardiography in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients, decreased rates of invasive coronary angiography testing in low-risk chest pain patients, and shorter lengths of admission in both groups, but no difference in in-hospital mortality in either group.

Bottom line: Although most hospitals in the US continue to use less sensitive troponin assays, implementation of hs-cTn assays is associated with positive outcomes including reduced length of stay, fewer invasive angiography procedures in low risk patients, and no difference in mortality.