Coronary disease & ACSSecondary analysis
Safety of Using Risk Stratification Along With High-Sensitivity Cardiac Troponin in the Emergency Department
- Secondary analysis of the HiSTORIC randomised trial
- stepped-wedge
- cluster-randomized
Authors' conclusion
Risk stratification with high-sensitivity cardiac troponin reduced length of stay and increased discharge from the emergency department in both low- and intermediate-risk patients with suspected acute coronary syndrome. Patients discharged from the emergency department were at lower risk of subsequent myocardial infarction or cardiac death at 1 year.
Study context
- Population
- Consecutive patients with suspected ACS at low (<5 ng/L) or intermediate (5 ng/L to 99th percentile) risk at presentation17,299 low / 14,193 intermediate risk
- Participants
- 31,492 patients
- Comparison
- low-risk vs intermediate-risk
- low-riskn = 17,299
- intermediate-riskn = 14,193
- Primary endpoint
- Length of hospital stay (primary effectiveness outcome)
Primary result
As reported in the abstract
Length of hospital stay
low-risk
6.9 ± 3.2
Before implementation · Following implementation 4.7 ± 2.8
intermediate-risk
15.8 ± 4.7
Before implementation · Following implementation 11.0 ± 4.9
Difference, hours (95% CI)P value
low-risk
2.2(0.7–3.7)
P < 0.001intermediate-risk
4.8(3.8–5.8)
P < 0.001Further findings
Discharge from ED
| Comparison | low-risk | intermediate-risk | adjusted OR (95% CI) | |
|---|---|---|---|---|
| low-risk · following vs before implementation | 3.31 (3.06–3.57) | |||
| Before implementation | 62% [4,962 of 7,941] | 36% [2,445 of 6,759] | ||
| Following implementation | 83% [7,747 of 9,358] | 55% [4,095 of 7,434] | ||
| intermediate-risk · following vs before implementation | 2.06 (1.92–2.21) | |||
| 0.20.5125Adjusted odds ratio (log scale) |
Original publication
Safety of Using Risk Stratification Along With High-Sensitivity Cardiac Troponin in the Emergency Department. J Am Coll Cardiol. Published 11 November 2025. doi:10.1016/j.jacc.2025.08.059
Summarised from the published abstract; every number is checked against it