Implementation of High-Sensitivity Cardiac Troponin Assay in Emergency Department Increases Myocardial Infarction Diagnosis and Utilization of Invasive Cardiac Procedures: an Insight from Middle East/Gulf Region

Introduction: Utilization of high-sensitivity cardiac troponin T (hsT) assays facilitates evaluation of patients with suspected acute coronary syndrome in emergency department (ED) by expediting clinical-decision making and disposition. While the utility of (hsT) has been previously shown, data from the Middle East/ Gulf region (MEG) are limited. We aimed to evaluate the association between hsT implementation and changes in resource use at a tertiary care center in MEG. Methods: Consecutive patients evaluated in ED using hsT (hsT era) or conventional troponin assays (pre-hsT era) were identified. Discharge diagnosis of myocardial infarction (MI), utilization of invasive and non-invasive testing (cardiac CT, perfusion imaging and stress echocardiography) during index admission was determined using ICD codes. Unadjusted rates of these outcomes in addition to in-hospital mortality were compared before and after adoption of hsT assays using appropriate tests. Results: Among 21,149 and 18,979 ED encounters before and after implementation hsT, mean patient age was 53.8 ± 18.1 and 53.3 ±17.8, (P=.09), respectively. The introduction of hsT assay was associated with a 23% increase in MI diagnosis (3.7% vs 3.0%; P<.001), 13% increase in invasive angiography use (4.4% vs. 3.9%; P=.02), and a concomitant 70% reduction in use of non-invasive studies (0.02% vs. 0.07%; P=.02). Additionally, mortality during index admission was significantly higher in the hsT era (1.3% vs. 1.1%; P=.01). Conclusion: Introduction of hsT assay at a single-center in MEG increased MI diagnosis and identified patients who are at increased risk of death. Furthermore, it was associated with greater use of invasive cardiac procedures. Whether more aggressive management during index hospitalization in this population is associated with favorable long-term outcomes requires additional studies.