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

被引：26

作者：

McCarthy, Cian ^{[1
,15
]}

Li, Shuang ^{[2
]}

Wang, Tracy Y. ^{[2
,3
]}

Raber, Inbar ^{[4
]}

Sandoval, Yader ^{[5
]}

Smilowitz, Nathaniel R. ^{[6
]}

Wasfy, Jason H. ^{[1
]}

Pandey, Ambarish ^{[7
]}

de Lemos, James A. ^{[7
]}

Kontos, Michael C. ^{[8
]}

Apple, Fred S. ^{[9
,10
]}

Daniels, Lori B. ^{[11
]}

Newby, L. Kristin ^{[2
,3
]}

Jaffe, Allan S. ^{[12
,13
]}

Januzzi, James L. ^{[1
,14
]}

机构：

[1] Massachusetts Gen Hosp, Dept Med, Div Cardiol, Boston, MA USA

[2] Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA

[3] Duke Univ, Med Ctr, Div Cardiol, Durham, NC USA

[4] Beth Israel Deaconess Med Ctr, Dept Med, Div Cardiol, Boston, MA USA

[5] Abbott NW Hosp, Minneapolis Heart Inst, Minneapolis, MN USA

[6] NYU, Dept Med, Leon H Charney Div Cardiol, Sch Med, New York, NY USA

[7] Univ Texas Southwestern Med Ctr Dallas, Div Cardiol, Dallas, TX USA

[8] Virginia Commonwealth Univ, Pauley Heart Ctr, Div Cardiol, Richmond, VA USA

[9] Hennepin Healthcare HCMC, Dept Lab Med & Pathol, Minneapolis, MN USA

[10] Univ Minnesota, Dept Lab Med & Pathol, Minneapolis, MN USA

[11] Univ Calif San Diego, Dept Med, Div Cardiovasc Med, La Jolla, CA USA

[12] Mayo Clin, Dept Cardiovasc Med, Rochester, MN USA

[13] Mayo Clin, Dept Lab Med & Pathol, Rochester, MN USA

[14] Baim Inst Clin Res, Heart Failure & Biomarker Trials, Boston, MA USA

[15] Massachusetts Gen Hosp, Dept Med, Div Cardiol, Boston, MA 02114 USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2023年 / 81卷 / 03期

关键词：

chest pain; high-sensitivity cardiac troponin assays; implementation; ACUTE CORONARY SYNDROMES; EARLY-DIAGNOSIS; TASK-FORCE; I ASSAY; IMPACT; MANAGEMENT; OUTCOMES; VALIDATION; GUIDELINES; ALGORITHM;

D O I：

10.1016/j.jacc.2022.10.017

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 1/4 251,000), 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 echocardi-ography for NSTE-ACS, and less use of invasive angiography among low-risk patients.(J Am Coll Cardiol 2023;81:207-219) (c) 2023 by the American College of Cardiology Foundation.

引用

页码：207 / 219

页数：13

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