High-sensitivity (hs) contemporary cardiac troponin (cTnT) implementation resulted in a marked increase in the number of patients diagnosed with myocardial injury and myocardial infarction (MI), particularly in women and patients with type 2 MI, according to a paper published May 3 in the Journal of the American College of Cardiology, and being presented at ACC.21.

Olatunde Ola, MD, MPH, et al., sought to evaluate the impact of hs-cTnT implementation in an observational U.S. cohort study of emergency department (ED) patients undergoing measurement of cTnT during the transition from 4th Gen cTnT to 5th Gen cTnT. Researchers evaluated 3,536 unique patients, including 1,738 patients with 2,069 ED encounters during the pre-implementation period, and 2,082 patients with 2,491 ED encounters during the post-implementation period. They also examined the use of resources including length of stay, hospitalizations and cardiac testing.

Results showed that compared to fourth Gen cTnT, encounters with >1 cTnT >99th percentile increased significantly using fifth Gen cTnT (15% vs. 47%). Acute MI (3.3% vs. 8.1%) and myocardial injury (11% vs. 38%) increased. Although type 1 MIs increased (1.7% vs. 2.9%), the overall MI increase was largely due to more type 2 MIs (1.6% vs. 5.2%). Women were less likely than men to have MI using 4th Gen cTnT (2.3% vs. 4.4%) but not 5th Gen cTnT (7.7% vs. 8.5%).

Researchers also found that overall length of stay and stress testing were reduced, but angiography increased. Among patients without cTnT increases, there were more ED discharges and a reduction in length of stay, echocardiography and stress tests.

"Further research as well as continuous interdisciplinary medical education is required to maximize the medical and economic value of hs-cTnT/I-testing to patients and institutions," write Christian Mueller, MD, et al., in an accompanying editorial comment. "This will help reduce overcrowding in the ED, reduce patient's anxiety and uncertainty, improve patients care, and significantly reduce health care costs."

Clinical Topics: Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and Imaging, Angiography, Echocardiography/Ultrasound, Nuclear Imaging

Keywords: ACC Annual Scientific Session, ACC21, Exercise Test, Troponin T, Myocardial Infarction, Emergency Service, Hospital, Echocardiography, Health Care Costs, Angiography, Diabetes Mellitus, Type 2

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