Beginning in July, patients who come to the North Kansas City Hospital Emergency Department with chest pain will receive a more sensitive blood test to determine if they are having a heart attack. The blood test — high-sensitivity troponin — measures low levels of the protein troponin in one’s blood for evidence of a myocardial infarction.
“High-sensitivity troponin blood tests provide faster results and detect lower levels and smaller changes of troponin over a conventional troponin blood test,” said Richard Mills, MD, a cardiologist with Meritas Health Cardiology. “The new assay is more effective at identifying very low-risk patients. This means myocardial infarctions can be ruled out sooner, which speeds ED discharges and avoids unnecessary additional testing and hospital admissions for some patients.”
Drew Nedved, MD, a pathologist with MAWD Pathology Group, pointed to NKCH’s evidence-based algorithm that, along with other clinical scores, defines patients as a low-, intermediate- or high-risk. Dr. Mills developed the algorithm with NKCH Laboratory and Pathology colleagues. “The algorithm helps us determine whether we need to continue monitoring a patient, need to refer a patient to Cardiology as a possible MI or can potentially discharge a patient as being negative for an MI,” Dr. Nedved said.
A study published in the Jan. 16, 2023, Journal of the American College of Cardiology showed use of high-sensitivity troponin was associated with a slightly shorter length of hospital stay, more use of echocardiography for non-ST segment elevation acute coronary syndrome and less use of invasive angiography in low-risk chest pain patients. In “Implementation of High-Sensitivity Cardiac Troponin Assays in the United States,” researchers used the ACC’s Chest Pain-MI Registry to examine the use of high-sensitivity troponin among 550 participating hospitals from Jan. 1, 2018-Sep. 30, 2021. Although investigators found a rise in high-sensitivity troponin use, they also reported only 33% of U.S. hospitals use the assay.
Proof that high-sensitivity troponin is the preferred biomarker for evaluating acute chest pain came with the 2021 Guideline for the Evaluation and Diagnosis of Chest Pain. The guideline was developed by the American College of Cardiology, American College of Chest Physicians, American Heart Association, American Society of Echocardiography, Society for Academic Emergency Medicine, Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance.
Richard Mills, MD
Dr. Mills earned his medical degree from Tufts University, Boston. He completed his internal medicine residency at the University of Texas Southwestern, Dallas, and his cardiovascular fellowship at the University of Missouri-Kansas City.
Drew Nedved, MD
Dr. Nedved earned his medical degree from the University of Kansas, where he completed his residency in pathology and fellowship in hematopathology.