• Christopher W Baugh, Ron Blankstein, Ishani Ganguli, James L Januzzi, David A Morrow, Joshua W Joseph, Claire Jordan, Gabrielle Donohoe, Jordyn Fofi, Katie McKinley, Mahyar Heydarpour, Benjamin M Scirica, Marcelo F DiCarli, and John T Nagurney.
• Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: cbaugh@partners.org.
• Am J Emerg Med. 2023 Oct 1; 72: 647164-71.

BackgroundAmong persons presenting to the emergency department with suspected acute myocardial infarction (MI), cardiac troponin (cTn) testing is commonly used to detect acute myocardial injury. Accelerated diagnostic protocols (ADPs) guide clinicians to integrate cTn results with other clinical information to decide whether to order further diagnostic testing.ObjectiveTo determine the change in the rate and yield of stress test or coronary CT angiogram following cTn measurement in patients with chest pain presenting to the emergency department pre- and post-transition to a high-sensitivity (hs-cTn) assay in an updated ADP.MethodsUsing electronic health records, we examined visits for chest pain at five emergency departments affiliated with an integrated academic health system 1-year pre- and post-hs-cTn assay transition. Outcomes included stress test or coronary imaging frequency, ADP compliance among those with additional testing, and diagnostic yield (ratio of positive tests to total tests).ResultsThere were 7564 patient-visits for chest pain, including 3665 in the pre- and 3899 in the post-period. Following the updated ADP using hs-cTn, 862 (23.5 per 100 patient visits) visits led to subsequent testing versus 1085 (27.8 per 100 patient visits) in the pre-hs-cTn period, (P < 0.001). Among those who were tested, the protocol-compliant rate fell from 80.9% to 46.5% (P < 0.001), but the yield of those tests rose from 24.5% to 29.2% (P = 0.07). Among tests that were noncompliant with ADP guidance, yield was similar pre- and post-updated hs-cTn ADP implementation (pre 13.0%, post 15.4% (P = 0.43).ConclusionImplementation of hs-cTn supported by an updated ADP was associated with a lower rate of stress testing and coronary CT angiogram.Copyright © 2023 Elsevier Inc. All rights reserved.

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