| _version_ | 1866902197294333952 |
|---|---|
| author | Raya Ahmed Alghamdi, Khalid Ali Alahmari, Khalid Raddad Alghashmari, Emad Fathi Adawi, Ali Mohammed Manqari, Ahmed Ali Ahmed Alzahrani, Mansour Salem Alalhareth, Mohammed Abed Alharthi, Raed Ghannam Aldaosari, Hamad Abdullah Alsleem |
| author_facet | Raya Ahmed Alghamdi, Khalid Ali Alahmari, Khalid Raddad Alghashmari, Emad Fathi Adawi, Ali Mohammed Manqari, Ahmed Ali Ahmed Alzahrani, Mansour Salem Alalhareth, Mohammed Abed Alharthi, Raed Ghannam Aldaosari, Hamad Abdullah Alsleem |
| contents | <div> <p><em><span lang="EN-GB">Chest pain is a leading cause of Emergency Department (ED) visits, posing a significant diagnostic challenge to identify acute coronary syndrome (ACS) efficiently. High-sensitivity cardiac troponin (hs-cTn) assays represent a major advance in cardiac biomarker technology, enabling more rapid and accurate risk stratification. This systematic review aims to synthesize the evidence on the utility of hs-cTn assays in the ED evaluation of chest pain, focusing on diagnostic performance, impact on patient management and workflow, long-term prognostic value, and implementation challenges. A systematic literature search was conducted in PubMed, Cochrane Library, and Embase for studies published from January 2000 to August 2023, following PRISMA guidelines. Fourteen studies meeting the inclusion criteria were selected after screening. Data on diagnostic accuracy, clinical outcomes, and operational metrics were extracted and synthesized. The integration of hs-cTn with clinical risk scores, particularly the HEART pathway, demonstrated exceptional diagnostic performance, with negative predictive values for acute myocardial infarction (AMI) exceeding 99.5%. This facilitated the safe and rapid discharge of 50-60% of low-risk patients, reducing median ED length of stay by 2.5 to 4.5 hours. Hs-cTn implementation also optimized admission patterns and reduced unnecessary downstream cardiac testing. Furthermore, baseline hs-cTn concentrations provided powerful long-term prognostic stratification, with 5-year mortality rates varying significantly between rule-out (5.6%), observe (14.7%), and rule-in (26.8%) groups. Key challenges identified include the critical need for analytical precision at low concentrations and standardized protocols to prevent patient misclassification.</span></em></p> <p><strong><em><span lang="EN-GB">Keywords:</span></em></strong><em><span lang="EN-GB"> High-sensitivity troponin, chest pain, emergency department, acute coronary syndrome, systematic review, HEART score, diagnostic accuracy, length of stay.</span></em></p> </div> |
| format | Recurso digital |
| id | zenodo_https___doi_org_10_5281_zenodo_17250110 |
| institution | Zenodo |
| language | |
| publishDate | 2025 |
| publisher | Zenodo |
| record_format | zenodo |
| spellingShingle | THE UTILITY OF HIGH SENSITIVITY TROPONIN ASSAYS IN EMERGENCY DEPARTMENT CHEST PAIN EVALUATION: A SYSTEMATIC REVIEW Raya Ahmed Alghamdi, Khalid Ali Alahmari, Khalid Raddad Alghashmari, Emad Fathi Adawi, Ali Mohammed Manqari, Ahmed Ali Ahmed Alzahrani, Mansour Salem Alalhareth, Mohammed Abed Alharthi, Raed Ghannam Aldaosari, Hamad Abdullah Alsleem <div> <p><em><span lang="EN-GB">Chest pain is a leading cause of Emergency Department (ED) visits, posing a significant diagnostic challenge to identify acute coronary syndrome (ACS) efficiently. High-sensitivity cardiac troponin (hs-cTn) assays represent a major advance in cardiac biomarker technology, enabling more rapid and accurate risk stratification. This systematic review aims to synthesize the evidence on the utility of hs-cTn assays in the ED evaluation of chest pain, focusing on diagnostic performance, impact on patient management and workflow, long-term prognostic value, and implementation challenges. A systematic literature search was conducted in PubMed, Cochrane Library, and Embase for studies published from January 2000 to August 2023, following PRISMA guidelines. Fourteen studies meeting the inclusion criteria were selected after screening. Data on diagnostic accuracy, clinical outcomes, and operational metrics were extracted and synthesized. The integration of hs-cTn with clinical risk scores, particularly the HEART pathway, demonstrated exceptional diagnostic performance, with negative predictive values for acute myocardial infarction (AMI) exceeding 99.5%. This facilitated the safe and rapid discharge of 50-60% of low-risk patients, reducing median ED length of stay by 2.5 to 4.5 hours. Hs-cTn implementation also optimized admission patterns and reduced unnecessary downstream cardiac testing. Furthermore, baseline hs-cTn concentrations provided powerful long-term prognostic stratification, with 5-year mortality rates varying significantly between rule-out (5.6%), observe (14.7%), and rule-in (26.8%) groups. Key challenges identified include the critical need for analytical precision at low concentrations and standardized protocols to prevent patient misclassification.</span></em></p> <p><strong><em><span lang="EN-GB">Keywords:</span></em></strong><em><span lang="EN-GB"> High-sensitivity troponin, chest pain, emergency department, acute coronary syndrome, systematic review, HEART score, diagnostic accuracy, length of stay.</span></em></p> </div> |
| title | THE UTILITY OF HIGH SENSITIVITY TROPONIN ASSAYS IN EMERGENCY DEPARTMENT CHEST PAIN EVALUATION: A SYSTEMATIC REVIEW |
| url | https://doi.org/10.5281/zenodo.17250110 |