• Arwa Younis, Shamroz Farooq, John D Bisognano, Thomas Welch, John P Gassler, Alexander Diamond, Andrew Mathias, Mehmet K Aktas, Scott McNitt, Anita Y Chen, and Ilan Goldenberg.
• Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York; Cardiac Electrophysiology Section, Cleveland Clinic, Cleveland, Ohio.
• J Emerg Med. 2022 May 1; 62 (5): 657-667.

BackgroundThe new high-sensitivity cardiac troponin T (hs-cTnT) is now widely used in the United States.ObjectivesWe aimed to examine outcomes associated with the introduction of the new 5th generation hs-cTnT assay among patients presenting to the emergency department (ED) with cardiovascular (CV) disorders.MethodsThe study comprised 5377 patients presenting to the ED with CV disorders between January and September 2018. Outcomes included rates of direct ED discharge, cardiac testing/procedures, and mortality. CV indications for troponin testing were categorized as rule-out acute coronary syndrome (RO-ACS) and other-CV (O-CV).ResultsMean age was 62 ± 17 years, and 47% were female. Demographics and medical history did not differ significantly between the troponin groups. The use of hs-cTnT was associated with increased rates of direct discharge from the ED in the RO-ACS (48% vs. 37%; p < 0.01), but not in the O-CV (25% vs. 25%) cohort. Cardiac tests/procedures were more often performed after hs-cTnT vs. cTnT testing in both cohorts (45% vs. 41% for RO-ACS, and 33% vs. 28% for O-CV; p < 0.05 for both). Multivariate analysis demonstrated that hs-cTnT was not associated with a significant increase in postdischarge mortality in both cohorts (RO-ACS: hazard ratio = 1.47 [p = 0.13], O-CV: hazard ratio = 0.97 [p = 0.87]).ConclusionsAmong patients with RO-ACS, hs-cTnT implementation resulted in increased rates of direct home discharge from the ED, without a significant increase in postdischarge mortality. Among patients presenting with O-CV indication, hs-cTnT implementation resulted in increased rates of cardiac testing procedures without an effect of ED discharge rates or long-term mortality.Copyright © 2022. Published by Elsevier Inc.

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