Observational studyJournal of the American College of Cardiology2021
Clinical Impact of High-Sensitivity Cardiac Troponin T Implementation in the Community.
Observational study in Journal of the American College of Cardiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 2 syntheses or guidelines pooled it, 61 citations in OpenAlex.
- Pooled it
- 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee.Journal of the American College of Cardiology · 2022Guideline
- Cardiac Magnetic Resonance Imaging Versus Invasive-Based Strategies in Patients With Chest Pain and Detectable to Mildly Elevated Serum Troponin: A Randomized Clinical Trial.Circulation. Cardiovascular imaging · 2023Trial
- Introduction of High-Sensitivity Troponin Assay to Rural Tertiary Care Medical Center: Impact on Subsequent Cardiac Diagnostic Testing.Diagnostics (Basel, Switzerland) · 2026Article
- Associations of High-Sensitivity Cardiac Troponin and N-Terminal Pro-B-Type Natriuretic Peptide With Echocardiographic Features in Patients With Hypertension.Journal of clinical hypertension (Greenwich, Conn.) · 2026Article
- Prevalence and Prognostic Implications of Atherosclerotic Coronary Artery Disease in Type 2 Myocardial Infarction.JACC. Advances · 2026Article
- The assessment and management of patients with type 2 myocardial infarction: an international Delphi study.European heart journal. Quality of care & clinical outcomes · 2025Article
- Revisiting High-Sensitivity Cardiac Troponin Abnormal Baseline Cutoffs: Implications for AMI Diagnosis in the Emergency Department.Journal of clinical medicine · 2025Article
- Causes of Myocardial Infarction in Younger Patients: Troponin-Elevation in Persons ≤65 Years Old in Olmsted County.Journal of the American College of Cardiology · 2025Article
- Real-World Clinical Impact of High-Sensitivity Troponin for Chest Pain Evaluation in the Emergency Department.Journal of the American Heart Association · 2025Article
- High-Sensitivity Cardiac Troponin Assays: From Implementation to Resource Utilization and Cost Effectiveness.The journal of applied laboratory medicine · 2025Review
- Clinical Outcomes, Healthcare Utilization, and Cost Following Implementation of a High-Sensitivity Cardiac Troponin Assay.Clinical cardiology · 2025Article
- Stress cardiovascular magnetic resonance imaging in intermediate-risk emergency department patients with abnormal high-sensitivity troponin.Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance · 2025Article
- Cardiac Troponins in Kidney Disease.European cardiology · 2025Review
- Article
- Cardiac Troponin Levels in Patients with Chronic Kidney Disease: "Markers of High Risk or Just Noise''?Diagnostics (Basel, Switzerland) · 2024Review
- Perioperative Mortality: A Retrospective Cohort Study of 75,446 Noncardiac Surgery Patients.Mayo Clinic proceedings. Innovations, quality & outcomes · 2024Article
- High-Sensitivity Cardiac Troponin T Reporting, Clinical Outcomes, and Health Care Resource Use.JAMA network open · 2024Article
- Improved Utilization of Serial Testing Without Increased Admissions after Implementation of High-Sensitivity Troponin I: a Controlled Retrospective Cohort Study.Journal of general internal medicine · 2024Article
- Cardiac Troponin in Patients With Light Chain and Transthyretin Cardiac Amyloidosis:JACC. CardioOncology · 2024Review
Corrections and comments
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Authors and funding
18 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundLimited U.S. data exist regarding high-sensitivity cardiac troponin (cTn) implementation.
objectivesThis study sought to evaluate the impact of high-sensitivity cardiac troponin T (cTnT) implementation.
methodsObservational 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.
resultsIn 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).
conclusionsHigh-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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.