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

Cian McCarthy; Shuang Li; Tracy Y. Wang; Inbar Raber; Yader Sandoval; Nathaniel R. Smilowitz; Jason H. Wasfy; Ambarish Pandey; James A. de Lemos; Michael C. Kontos; Fred S. Apple; Lori B. Daniels; L. Kristin Newby; Allan S. Jaffe; James L. Januzzi

doi:10.1016/j.jacc.2022.10.017

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

Cian McCarthy, Shuang Li, Tracy Y. Wang, Inbar Raber, Yader Sandoval, Nathaniel R. Smilowitz, Jason H. Wasfy, Ambarish Pandey, James A. de Lemos, Michael C. Kontos, Fred S. Apple, Lori B. Daniels, L. Kristin Newby, Allan S. Jaffe, James L. Januzzi

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13 Scopus citations

Abstract

Background: Few data exist regarding the implementation of high-sensitivity cardiac troponin (hs-cTn) assays in the United States since their approval. Objectives: This study sought to explore trends in hs-cTn assay implementation over time and assess the association of their use with in-hospital cardiac testing and outcomes. Methods: The study examined trends in implementation of hs-cTn assays among participating hospitals in the National Cardiovascular Data Registry Chest Pain-MI [Myocardial Infarction] Registry from January 1, 2019 through September 30, 2021. Associations among hs-cTn use, use of in-hospital diagnostic imaging, and patient outcomes were assessed using generalized estimating equation models with logistic or gamma distributions. Results: Among 550 participating hospitals (N = 251,000), implementation of hs-cTn assays increased from 3.3% in the first quarter of 2019 to 32.6% in the third quarter of 2021 (P_trend < 0.001). Use of hs-cTn was associated with more echocardiography among persons with non–ST-segment elevation acute coronary syndrome (NSTE-ACS; 82.4% vs 75.0%; adjusted odds ratio: 1.43; 95% CI: 1.19-1.73) but not among low-risk chest pain individuals. Use of hs-cTn was associated with less invasive coronary angiography among low-risk patients (3.7% vs 4.5%; adjusted odds ratio: 0.73; 95% CI: 0.58-0.92) but similar use for patients with NSTE-ACS. There was no association between hs-cTn use and noninvasive stress testing or coronary computed tomography angiography testing. Among individuals with NSTE-ACS, hs-cTn use was not associated with revascularization or in-hospital mortality. Use of hs-cTn was associated with a shorter length of stay (median 47.6 hours vs 48.0 hours; ratio: 0.94; 95% CI: 0.90-0.98). Conclusions: Implementation of hs-cTn among U.S. hospitals is increasing, but most U.S. hospitals continue to use less sensitive assays. The use of hs-cTn was associated with modestly shorter length of stay, greater use of echocardiography for NSTE-ACS, and less use of invasive angiography among low-risk patients.

Original language	English (US)
Pages (from-to)	207-219
Number of pages	13
Journal	Journal of the American College of Cardiology
Volume	81
Issue number	3
DOIs	https://doi.org/10.1016/j.jacc.2022.10.017
State	Published - Jan 24 2023

Keywords

chest pain
high-sensitivity cardiac troponin assays
implementation

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.jacc.2022.10.017

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McCarthy, C., Li, S., Wang, T. Y., Raber, I., Sandoval, Y., Smilowitz, N. R., Wasfy, J. H., Pandey, A., de Lemos, J. A., Kontos, M. C., Apple, F. S., Daniels, L. B., Newby, L. K., Jaffe, A. S., & Januzzi, J. L. (2023). Implementation of High-Sensitivity Cardiac Troponin Assays in the United States. Journal of the American College of Cardiology, 81(3), 207-219. https://doi.org/10.1016/j.jacc.2022.10.017

McCarthy, C, Li, S, Wang, TY, Raber, I, Sandoval, Y, Smilowitz, NR, Wasfy, JH, Pandey, A , de Lemos, JA, Kontos, MC, Apple, FS, Daniels, LB, Newby, LK, Jaffe, AS & Januzzi, JL 2023, 'Implementation of High-Sensitivity Cardiac Troponin Assays in the United States', Journal of the American College of Cardiology, vol. 81, no. 3, pp. 207-219. https://doi.org/10.1016/j.jacc.2022.10.017

@article{073df8c600e74ec384ccb49881653a28,

title = "Implementation of High-Sensitivity Cardiac Troponin Assays in the United States",

abstract = "Background: Few data exist regarding the implementation of high-sensitivity cardiac troponin (hs-cTn) assays in the United States since their approval. Objectives: This study sought to explore trends in hs-cTn assay implementation over time and assess the association of their use with in-hospital cardiac testing and outcomes. Methods: The study examined trends in implementation of hs-cTn assays among participating hospitals in the National Cardiovascular Data Registry Chest Pain-MI [Myocardial Infarction] Registry from January 1, 2019 through September 30, 2021. Associations among hs-cTn use, use of in-hospital diagnostic imaging, and patient outcomes were assessed using generalized estimating equation models with logistic or gamma distributions. Results: Among 550 participating hospitals (N = 251,000), implementation of hs-cTn assays increased from 3.3% in the first quarter of 2019 to 32.6% in the third quarter of 2021 (Ptrend < 0.001). Use of hs-cTn was associated with more echocardiography among persons with non–ST-segment elevation acute coronary syndrome (NSTE-ACS; 82.4% vs 75.0%; adjusted odds ratio: 1.43; 95% CI: 1.19-1.73) but not among low-risk chest pain individuals. Use of hs-cTn was associated with less invasive coronary angiography among low-risk patients (3.7% vs 4.5%; adjusted odds ratio: 0.73; 95% CI: 0.58-0.92) but similar use for patients with NSTE-ACS. There was no association between hs-cTn use and noninvasive stress testing or coronary computed tomography angiography testing. Among individuals with NSTE-ACS, hs-cTn use was not associated with revascularization or in-hospital mortality. Use of hs-cTn was associated with a shorter length of stay (median 47.6 hours vs 48.0 hours; ratio: 0.94; 95% CI: 0.90-0.98). Conclusions: Implementation of hs-cTn among U.S. hospitals is increasing, but most U.S. hospitals continue to use less sensitive assays. The use of hs-cTn was associated with modestly shorter length of stay, greater use of echocardiography for NSTE-ACS, and less use of invasive angiography among low-risk patients.",

keywords = "chest pain, high-sensitivity cardiac troponin assays, implementation",

author = "Cian McCarthy and Shuang Li and Wang, {Tracy Y.} and Inbar Raber and Yader Sandoval and Smilowitz, {Nathaniel R.} and Wasfy, {Jason H.} and Ambarish Pandey and {de Lemos}, {James A.} and Kontos, {Michael C.} and Apple, {Fred S.} and Daniels, {Lori B.} and Newby, {L. Kristin} and Jaffe, {Allan S.} and Januzzi, {James L.}",

note = "Publisher Copyright: {\textcopyright} 2023 American College of Cardiology Foundation",

year = "2023",

month = jan,

day = "24",

doi = "10.1016/j.jacc.2022.10.017",

language = "English (US)",

volume = "81",

pages = "207--219",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "3",

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TY - JOUR

T1 - Implementation of High-Sensitivity Cardiac Troponin Assays in the United States

AU - McCarthy, Cian

AU - Li, Shuang

AU - Wang, Tracy Y.

AU - Raber, Inbar

AU - Sandoval, Yader

AU - Smilowitz, Nathaniel R.

AU - Wasfy, Jason H.

AU - Pandey, Ambarish

AU - de Lemos, James A.

AU - Kontos, Michael C.

AU - Apple, Fred S.

AU - Daniels, Lori B.

AU - Newby, L. Kristin

AU - Jaffe, Allan S.

AU - Januzzi, James L.

PY - 2023/1/24

Y1 - 2023/1/24

N2 - Background: Few data exist regarding the implementation of high-sensitivity cardiac troponin (hs-cTn) assays in the United States since their approval. Objectives: This study sought to explore trends in hs-cTn assay implementation over time and assess the association of their use with in-hospital cardiac testing and outcomes. Methods: The study examined trends in implementation of hs-cTn assays among participating hospitals in the National Cardiovascular Data Registry Chest Pain-MI [Myocardial Infarction] Registry from January 1, 2019 through September 30, 2021. Associations among hs-cTn use, use of in-hospital diagnostic imaging, and patient outcomes were assessed using generalized estimating equation models with logistic or gamma distributions. Results: Among 550 participating hospitals (N = 251,000), implementation of hs-cTn assays increased from 3.3% in the first quarter of 2019 to 32.6% in the third quarter of 2021 (Ptrend < 0.001). Use of hs-cTn was associated with more echocardiography among persons with non–ST-segment elevation acute coronary syndrome (NSTE-ACS; 82.4% vs 75.0%; adjusted odds ratio: 1.43; 95% CI: 1.19-1.73) but not among low-risk chest pain individuals. Use of hs-cTn was associated with less invasive coronary angiography among low-risk patients (3.7% vs 4.5%; adjusted odds ratio: 0.73; 95% CI: 0.58-0.92) but similar use for patients with NSTE-ACS. There was no association between hs-cTn use and noninvasive stress testing or coronary computed tomography angiography testing. Among individuals with NSTE-ACS, hs-cTn use was not associated with revascularization or in-hospital mortality. Use of hs-cTn was associated with a shorter length of stay (median 47.6 hours vs 48.0 hours; ratio: 0.94; 95% CI: 0.90-0.98). Conclusions: Implementation of hs-cTn among U.S. hospitals is increasing, but most U.S. hospitals continue to use less sensitive assays. The use of hs-cTn was associated with modestly shorter length of stay, greater use of echocardiography for NSTE-ACS, and less use of invasive angiography among low-risk patients.

AB - Background: Few data exist regarding the implementation of high-sensitivity cardiac troponin (hs-cTn) assays in the United States since their approval. Objectives: This study sought to explore trends in hs-cTn assay implementation over time and assess the association of their use with in-hospital cardiac testing and outcomes. Methods: The study examined trends in implementation of hs-cTn assays among participating hospitals in the National Cardiovascular Data Registry Chest Pain-MI [Myocardial Infarction] Registry from January 1, 2019 through September 30, 2021. Associations among hs-cTn use, use of in-hospital diagnostic imaging, and patient outcomes were assessed using generalized estimating equation models with logistic or gamma distributions. Results: Among 550 participating hospitals (N = 251,000), implementation of hs-cTn assays increased from 3.3% in the first quarter of 2019 to 32.6% in the third quarter of 2021 (Ptrend < 0.001). Use of hs-cTn was associated with more echocardiography among persons with non–ST-segment elevation acute coronary syndrome (NSTE-ACS; 82.4% vs 75.0%; adjusted odds ratio: 1.43; 95% CI: 1.19-1.73) but not among low-risk chest pain individuals. Use of hs-cTn was associated with less invasive coronary angiography among low-risk patients (3.7% vs 4.5%; adjusted odds ratio: 0.73; 95% CI: 0.58-0.92) but similar use for patients with NSTE-ACS. There was no association between hs-cTn use and noninvasive stress testing or coronary computed tomography angiography testing. Among individuals with NSTE-ACS, hs-cTn use was not associated with revascularization or in-hospital mortality. Use of hs-cTn was associated with a shorter length of stay (median 47.6 hours vs 48.0 hours; ratio: 0.94; 95% CI: 0.90-0.98). Conclusions: Implementation of hs-cTn among U.S. hospitals is increasing, but most U.S. hospitals continue to use less sensitive assays. The use of hs-cTn was associated with modestly shorter length of stay, greater use of echocardiography for NSTE-ACS, and less use of invasive angiography among low-risk patients.

KW - chest pain

KW - high-sensitivity cardiac troponin assays

KW - implementation

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

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