An accelerated diagnostic pathway that tested for high-sensitivity cardiac troponin I (hs-cTnI) at the point of care (POC) compared with core laboratory-tested hs-cTn was safe and reduced the length of stay in the emergency department (ED) in patients presenting with a possible myocardial infarction (MI), according to results from the pragmatic, stepped wedge ICare-FASTER trial published Oct. 19 in Circulation.

Conducted at six sites of different sizes across New Zealand from February 2023 through January 2025, the pragmatic, stepped-wedge, cluster-randomized trial compared outcomes in patients randomized to usual care that used a single-sample rule-out core laboratory hs-cTn assay and the intervention arm that used the POC hs-cTnI assay in the accelerated diagnostic pathway. The mean age of participants was 61 years, and half were women.

Martin Paul Than, MBBS, FACC, et al., defined the primary outcome as ED length of stay (measured in minutes) assessed using a generalized linear mixed model, and the safety outcome as MI or cardiac death within 30 days.

Over the two-year study, there were nearly 60,000 ED presentations, of which 31,392 were in the intervention arm. Results showed a 13% reduction in the primary outcome with the intervention compared with usual care (329 minutes vs. 376 minutes, a difference of 47 minutes), after adjustment for covariates associated with length of stay. The occurrence of the safety income was similar in both groups at 0.39% each.

In what the authors say is the first evaluation of a POC hs-cTnI strategy in routine clinical care, the reduction in length of stay did not increase 30-day MI or cardiac death. "Such a change is clinically meaningful and occurred despite a 23.4% increase in overall ED attendance," write the authors, adding that implementing this strategy could substantially reduce ED occupancy.