Comparison of High-Sensitivity Troponin T Assay to Conventional Troponin T Assay for Rule Out of Acute Coronary Syndrome in the Emergency Department

Approximately 5% of all emergency department (ED) visits require evaluation of chest pain and atypical symptoms for diagnosis or exclusion of myocardial infarction or acute coronary syndrome (ACS) (P. Rui, K. Kang, & J. J. Ashman, 2016). Health care providers rely on effective tests and assessment protocols for definitive diagnosis of ACS. Cardiac biomarkers in troponin T assays enable rapid exclusion of ACS. This project compared high-sensitivity troponin T assay to conventional troponin T assay in reducing unnecessary stress tests for ACS exclusion, length of stay in the ED, and rate of readmissions within 30 days after ACS exclusion and discharge. A retrospective review of 300 medical records for exclusion of ACS compared 150 patients receiving conventional troponin T assay and 150 patients receiving high-sensitivity troponin T assay. The mean length of stay in the preintervention group was 8.3 hr (SD = 1.60) compared with 3.9 hr (SD = 1.56) in the postintervention group (t((298)) = 24.56, p < 0.001). A significant difference was found in necessary and unnecessary stress testing (X-(1)(2) =17.42, p < 0.05). The preintervention group had significantly more normal stress tests and the postintervention group had significantly more abnormal stress tests. In the preintervention group, 4 (2.7%) patients were readmitted within 30 days with ACS; no readmissions were reported for the postintervention group. Findings supported outcome improvements with the high-sensitivity troponin T assay. Using high-sensitivity troponin T assay in the diagnosis protocol can improve length of stay for patients with exclusion of ACS and reduce unnecessary stress tests during the ED stay.