Journal of Cardiovascular Development and Disease · Published 2026-07-14 · DOI 10.3390/jcdd13070328
Wanyi Chen, Allan S. Jaffe, Fred S. Apple, Christopher deFilippi, William Frank Peacock, Alan H. B. Wu, Rana Fayyad, Sarah Bethoney, Jingjing Zhang, Artem T. Boltyenkov
Most patients with chest pain do not have acute myocardial infarction (AMI), yet post-AMI rule-out disposition remains variable. Detectable but sub-99th percentile high-sensitivity cardiac troponin I (hs-cTnI) provides additional prognostic information. We evaluated the economic value of hs-cTnI-guided hospitalizations among non-AMI patients. We analyzed 1481 non-AMI chest pain visits with detectable baseline hs-cTnI across 29 U.S. emergency departments (2014–2016) in the prospective HIGH-US trial using the Atellica IM TnIH assay(Siemens Healthcare Diagnostics, Tarrytown, NY, US). We compared observed standard-of-care admissions with modeled pathways incorporating hs-cTnI thresholds and risk scores, assessing admission rates, costs, and diagnostic accuracy for 30-day death/MI. Overall, 1.0% (<i>n</i> = 15/1481) experienced 30-day death/MI. Standard-of-care admitted 59% of patients with 93% sensitivity and 41% specificity. The modeled pathway using hs-cTnI ≥ 5 ng/L plus non-low risk scores was associated with reduced projected admission of 41%, higher specificity of 60%, and the same 93% sensitivity. Estimated per-patient diagnostic costs were lower under Scenario 1 (noninvasive diagnostic testing only; $1025 vs. $1139) and under Scenario 2 (including inpatient/invasive procedures; $2672 vs. $3536). In subgroups, higher hs-cTnI thresholds conferred further economic benefit without compromising sensitivity. Incorporating sub-99th percentile hs-cTnI thresholds alongside risk scores may support more efficient resource use while maintaining safety, although findings require prospective validation.
Abstract from DOAJ. Public domain (CC0 1.0).
Read the article at the publisher →
Chen, W., Jaffe, A., Apple, F., et al. (2026). Clinical and Economic Implications of High-Sensitivity Troponin-Informed Admission Strategies in Non-AMI Chest Pain. Journal of Cardiovascular Development and Disease. https://doi.org/10.3390/jcdd13070328