Clinical Impact of High-Sensitivity Cardiac Troponin T Implementation in the Community

Olatunde Ola, Ashok Akula, Laura De Michieli, Marshall Dworak, Erika Crockford, Ronstan Lobo, Nicholas Rastas, Jonathan D. Knott, Ramila A. Mehta, David O. Hodge, Eric Grube, Swetha Karturi, Scott Wohlrab, Tahir Tak, Charles Cagin, Rajiv Gulati, Allan S. Jaffe, Yader Sandoval

Research output: Contribution to journalArticlepeer-review


Background: Limited U.S. data exist regarding high-sensitivity cardiac troponin (cTn) implementation. Objectives: This study sought to evaluate the impact of high-sensitivity cardiac troponin T (cTnT) implementation. Methods: Observational U.S. cohort study of emergency department (ED) patients undergoing measurement of cTnT during the transition from 4th (pre-implementation March 12, 2018, to September 11, 2018) to 5th generation (Gen) cTnT (post-implementation September 12, 2018, to March 11, 2019). Diagnoses were adjudicated following the Fourth Universal Definition of Myocardial Infarction (MI). Resources evaluated included length of stay, hospitalizations, and cardiac testing. Results: In this study, 3,536 unique patients were evaluated, including 2,069 and 2,491 ED encounters pre- and post-implementation. Compared with 4th Gen cTnT, encounters with ≥1 cTnT >99th percentile increased using 5th Gen cTnT (15% vs. 47%; p < 0.0001). Acute MI (3.3% vs. 8.1%; p < 0.0001) and myocardial injury (11% vs. 38%; p < 0.0001) increased. Although type 1 MIs increased (1.7% vs. 2.9%; p = 0.0097), the overall MI increase was largely due to more type 2 MIs (1.6% vs. 5.2%; p < 0.0001). Women were less likely than men to have MI using 4th Gen cTnT (2.3% vs. 4.4%; p = 0.008) but not 5th Gen cTnT (7.7% vs. 8.5%; p = 0.46). Overall length of stay and stress testing were reduced, and angiography was increased (all p < 0.05). Among those without cTnT increases, there were more ED discharges and a reduction in length of stay, echocardiography, and stress tests (all p < 0.05). Conclusions: High-sensitivity cTnT implementation resulted in a marked increase in myocardial injury and MI, particularly in women and patients with type 2 MI. Despite this, except for angiography, overall resource use did not increase. Among those without cTnT increases, there were more ED discharges and fewer cardiac tests.

Original languageEnglish (US)
Pages (from-to)3160-3170
Number of pages11
JournalJournal of the American College of Cardiology
Issue number25
StatePublished - Jun 29 2021


  • cardiac troponin
  • myocardial infarction
  • myocardial injury
  • resource utilization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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