NCDR Study Examines Implementation of hs-cTn Assays in US

High-sensitivity cardiac troponin (hs-cTn) assay use in the U.S. is increasing and may be associated with shorter hospital stays, greater use of echocardiography for non-ST-segment elevation acute coronary syndrome (NSTE-ACS), and less use of invasive angiography, according to a study published Jan. 16 in JACC.

Cian McCarthy, MB, BCH, BAO, et al., used data from ACC’s Chest Pain – MI Registry to examine trends in the implementation of hs-cTn assays among 550 participating hospitals from Jan. 1, 2018, through Sep. 30, 2021.

Results show that implementation of hs-cTn assays increased in the U.S. from 3.3% in 2019 to 32.6% in 2021 (p trend <0.001), yet most U.S. hospitals continued to use less sensitive cTn assays. In addition, the use of hs-cTn was associated with greater use of echocardiography for NSTE-ACS (82.4% vs. 75.0%; adjusted OR: 1.43; 95% CI: 1.19-1.73) but not among low-risk chest pain patients.

While the use of hs-cTn was associated with less invasive coronary angiography among low-risk patients (3.7% vs 4.5%; adjusted OR: 0.73; 95% CI: 0.58-0.92), there was no difference in the patients with NSTE-ACS. Further, after adjusting for confounding variables, the use of hs-cTn was associated with a “slightly but significantly shorter” length of stay (median 47.6 hours vs. 48.0 hours; ratio: 0.94; 95% CI: 0.90-0.98).

The authors conclude that their data “suggest favorable changes in the appropriateness of subsequent testing” and that moving forward, following the 2021 AHA/ACC chest pain guideline, “unnecessary testing in low-risk chest pain patients may be further reduced when these patients are assessed with hs-cTn assays.”

In an accompanying editorial comment, Martha Gulati, MD, MS, FACC, and David D. Berg, MD, MPH, FACC, note that this is the largest observational study of hs-cTn in U.S. hospitals to date. They add that the study “underscores the persistent implementation gap that is unfortunately all too common with novel cardiovascular technologies.” They hope that the study helps to “motivate quality improvement efforts to more effectively implement hs-cTn in U.S. hospitals.”

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Registries, Troponin, Coronary Angiography, Chest Pain, Length of Stay, Confounding Factors, Epidemiologic, Acute Coronary Syndrome, Chest Pain MI Registry, National Cardiovascular Data Registries

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