{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T04:04:43Z","timestamp":1784001883506,"version":"3.55.0"},"reference-count":45,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Siemens Healthcare Diagnostics Inc."}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>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\u20132016) 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% (n = 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 \u2265 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.<\/jats:p>","DOI":"10.3390\/jcdd13070328","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T02:34:44Z","timestamp":1783996484000},"page":"328","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and Economic Implications of High-Sensitivity Troponin-Informed Admission Strategies in Non-AMI Chest Pain"],"prefix":"10.3390","volume":"13","author":[{"given":"Wanyi","family":"Chen","sequence":"first","affiliation":[{"name":"Medical Affairs, Siemens Healthcare Diagnostic Inc., Tarrytown, NY 10591, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1183-3959","authenticated-orcid":false,"given":"Allan S.","family":"Jaffe","sequence":"additional","affiliation":[{"name":"Cardiovascular Department and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred S.","family":"Apple","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Hennepin Healthcare\/Hennepin County Medical Center, Minneapolis, MN 55404, USA"},{"name":"Hennepin Healthcare Research Institute, Minneapolis, MN 55404, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"deFilippi","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2730-6742","authenticated-orcid":false,"given":"William Frank","family":"Peacock","sequence":"additional","affiliation":[{"name":"Emergency Department, Ben Taub Hospital, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan H. B.","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, University of California, San Francisco, CA 94143, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rana","family":"Fayyad","sequence":"additional","affiliation":[{"name":"Medical Affairs, Siemens Healthcare Diagnostic Inc., Tarrytown, NY 10591, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8425-7138","authenticated-orcid":false,"given":"Sarah","family":"Bethoney","sequence":"additional","affiliation":[{"name":"Medical Affairs, Siemens Healthcare Diagnostic Inc., Tarrytown, NY 10591, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingjing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Medical Affairs, Siemens Healthcare Diagnostic Inc., Tarrytown, NY 10591, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1143-5750","authenticated-orcid":false,"given":"Artem T.","family":"Boltyenkov","sequence":"additional","affiliation":[{"name":"Medical Affairs, Siemens Healthcare Diagnostic Inc., Tarrytown, NY 10591, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/HPC.0000000000000164","article-title":"Implementation of an Emergency Department High-Sensitivity Troponin Chest Pain Pathway in the United States","volume":"18","author":"Baugh","year":"2019","journal-title":"Crit. 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