Circulation最新文献

{"title":"Correction to: Abstract 4365705: Cardiology Medications and Medicare Spending: Opportunities for Savings Using Mark Cuban Cost Plus Drug Company and Costco Member Prescription Program Pricing.","authors":"Katherine Schoeffler, Stephanie Day, Hemanth Sanjamala, Alireza Danesh, Isaac Rosales, Zachary Fennell, Atticus Aguilar, Suparshva Parikh, Ryan Nipp","doi":"10.1161/CIR.0000000000001484","DOIUrl":"https://doi.org/10.1161/CIR.0000000000001484","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"154 16","pages":"e654"},"PeriodicalIF":41.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter by Fauchier et al Regarding Article, \"Polycystic Ovarian Syndrome and the Long-Term Risk of Arrhythmias\".","authors":"Laurent Fauchier, Thibault Lenormand, Lisa Lochon","doi":"10.1161/CIRCULATIONAHA.126.080602","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.080602","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"154 16","pages":"e621-e622"},"PeriodicalIF":41.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State of Cardiovascular Disease and Stroke in Hispanic/Latino Adults in the United States: A Scientific Statement From the American Heart Association.","authors":"Johanna Contreras, David Aguilar, Katia Bravo-Jaimes, Yamnia Cortes, Salvador Cruz-Flores, Jorge R Kizer, Ileana Piña, Harrison Bonilla, Carlos J Rodriguez, Fatima Rodriguez, Gladys Velarde","doi":"10.1161/CIR.0000000000001463","DOIUrl":"10.1161/CIR.0000000000001463","url":null,"abstract":"<p><p>Cardiovascular disease became the leading cause of death among Hispanic individuals in the United States in 2022. Hispanic adults experience a disproportionate burden of cardiometabolic risk factors, including obesity, diabetes, and dyslipidemia. Hispanic populations are highly heterogeneous, with substantial variations in genetic ancestry and sociocultural influences that shape cardiovascular disease risk and outcomes. The \"Hispanic paradox,\" describing lower cardiovascular disease mortality despite higher risk factor burden, is increasingly recognized as an oversimplification that does not apply uniformly across Hispanic heritage groups, sexes, or disease types. Disaggregated data reveal substantial differences in risk profiles and disease burden among Hispanic heritage groups, emphasizing the limitations of treating this population as a monolithic unit. Recent evidence demonstrates widening disparities in hypertension control, obesity, diabetes, and metabolic diseases among Hispanic populations, threatening this prior mortality advantage. Advancing cardiovascular and equitable health will require developing a deeper understanding of the unique drivers of cardiovascular disease within diverse Hispanic communities, addressing barriers such as language and insurance access, and implementing culturally tailored interventions and policies. This scientific statement summarizes current cardiovascular disease epidemiology in Hispanic populations, emphasizing heritage group variation and social and structural determinants of health, and presents strategies to improve prevention and healthcare delivery. Key priorities for advancing cardiovascular health in Hispanic adults include expanding disaggregated data collection, increasing representation in research, and ensuring equitable implementation of precision medicine approaches, including genomics, multi-omics, and artificial intelligence, while addressing environmental exposures, psychosocial stressors, and policy-related drivers of risk in order to achieve the American Heart Association's 2028 Impact Goals to advancing health and hope for everyone, everywhere.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"e625-e639"},"PeriodicalIF":41.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Atrial Myxoma.","authors":"Christopher Mason, Adam Ungemach, Gloria Ayuba","doi":"10.1161/CIRCULATIONAHA.126.081728","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.081728","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"154 16","pages":"1649"},"PeriodicalIF":41.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve From a Large Nationwide Cohort.","authors":"Jack S Bell, Edward Nicol, Vinod Venugopal, Liam Mullen, Laurence Tidbury, Matthew Shaw, Campbell Rogers, Sarah Mullen, Bjarne Linde Nørgaard, Jonathon Leipsic, Jonathan R Weir-McCall, Timothy A Fairbairn","doi":"10.1161/CIRCULATIONAHA.126.081264","DOIUrl":"10.1161/CIRCULATIONAHA.126.081264","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The diagnostic value of coronary computed tomography angiography-derived fractional flow reserve (FFR-CT) in stable coronary artery disease is well established. The prognostic value of predicting future cardiovascular events is less clear, as studies are limited by small populations, variable measurement points, composite outcomes, and short follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;A nationwide cohort of coronary computed tomography angiography with 3-year follow-up was used to examine the association between FFR-CT measurements and future cardiovascular events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients receiving coronary computed tomography angiography and clinically indicated FFR-CT analysis (HeartFlow) for stable coronary artery disease between 2017 and 2020 at 27 sites across England were included. Lowest per-patient stenosis-specific and distal vessel FFR-CT measurements were related to individual outcomes of myocardial infarction (MI), cardiovascular mortality, all-cause mortality, and revascularization. FFR-CT measurements were divided into subgroups to investigate for a gradient of risk: normal FFR-CT (&gt;0.8), borderline (0.71-0.8), reduced (0.51-0.7), and severely reduced (≤0.5).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 7836 patients aged 63 (56.0-71.0), 37.4% women, underwent FFR-CT analysis. Stenosis-specific FFR-CT was associated with future MI (hazard ratio [HR], 2.08-5.73; &lt;i&gt;P&lt;/i&gt;&lt;0.001), cardiovascular death (HR, 1.51-3.40; &lt;i&gt;P&lt;/i&gt;&lt;0.001), all-cause death (HR, 1.01-1.58; &lt;i&gt;P&lt;/i&gt;=0.01), and revascularization (HR, 4.79-24.48; &lt;i&gt;P&lt;/i&gt;&lt;0.001), with lower FFR-CT values associated with incrementally greater risk. After adjusting for cardiovascular risk factors and coronary stenosis severity (Coronary Artery Disease Reporting and Data System), stenosis-specific FFR-CT≤0.7 was associated with MI (adjusted HR, 2.94-3.39; &lt;i&gt;P&lt;/i&gt;&lt;0.001), ≤0.5 with cardiovascular death (adjusted HR, 2.92; &lt;i&gt;P&lt;/i&gt;=0.02), all-cause death (adjusted HR, 1.49; &lt;i&gt;P&lt;/i&gt;=0.045), and ≤0.8 with revascularization (adjusted HR, 3.02-9.42; &lt;i&gt;P&lt;/i&gt;&lt;0.001). The addition of FFR-CT improved discrimination for MI or cardiovascular death compared with a risk factor and stenosis severity model (C index, 0.783; ∆C index, 0.012; &lt;i&gt;P&lt;/i&gt;&lt;0.001). An FFR-CT value of 0.67 defined the optimal cutoff for risk of future cardiovascular events. Distal-vessel FFR-CT was associated with outcomes similar to stenosis-specific FFR-CT. Stenosis-specific and distal-vessel FFR-CT discordance was common (36.4%), but when stenosis-specific FFR-CT was normal, event rates were low (1.5% at 3 years for MI or cardiovascular death).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;FFR-CT is associated with the individual outcomes of MI, cardiovascular death, and all-cause death independent of risk factors and stenosis severity, with lower FFR-CT values associated with worse outcomes. Reduced and severely reduced FFR-CT have the strongest association with future cardiovascu","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"1580-1591"},"PeriodicalIF":41.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Efficacy of Aficamten in Nonobstructive Hypertrophic Cardiomyopathy: Results From ACACIA-HCM.","authors":"Martin S Maron, Ahmad Masri, Ankit Bhatia, Maria Luisa Peña-Peña, Mark V Sherrid, Estevao Lanna Figueiredo, Michael Arad, Lubna Choudhury, Brian L Claggett, Caroline J Coats, Edileide de Barros Correia, Juan Pablo Costabel, Perry M Elliott, Jorge E Silva Enciso, Junbo Ge, Carolyn Y Ho, Ian Kulac, Gregory D Lewis, Matthew W Martinez, Mathew S Maurer, Michelle Michels, Sumeet S Mitter, Jesus E Pino Moreno, Iacopo Olivotto, Anjali T Owens, Steen H Poulsen, Florian Rader, Ethan J Rowin, P Christian Schulze, Robert Sepp, Nikhil Sikand, Scott D Solomon, John A Spertus, Xiaoyan Zhao, Punag H Divanji, Stephen B Heitner, Daniel L Jacoby, Stuart Kupfer, Fady I Malik, Joel Salazar-Mendiguchía, Amy Wohltman, Shu Zhuo, Roberto Barriales-Villa","doi":"10.1161/CIRCULATIONAHA.126.082026","DOIUrl":"10.1161/CIRCULATIONAHA.126.082026","url":null,"abstract":"<p><strong>Background: </strong>Nonobstructive hypertrophic cardiomyopathy (nHCM) is associated with significant morbidity with no approved treatment. Aficamten is a cardiac myosin inhibitor targeting excess contractility and diastolic impairment, the predominant mechanism responsible for adverse outcomes in nHCM. In the ACACIA-HCM trial (Assessment Comparing Aficamten to Placebo on Cardiac Endpoints in Adults With Non-Obstructive HCM; URL: https://www.clinicaltrials.gov; Unique identifier: NCT06081894), aficamten significantly improved outcomes in patients with nHCM versus placebo. To contextualize the observed treatment effects, we performed a responder analysis integrating multiple clinically relevant measures.</p><p><strong>Methods: </strong>Patients with symptomatic nHCM were randomized to daily aficamten (n=258) or placebo (n=259) assessed at week 36, including (1) symptom burden (≥1 improvement in New York Heart Association class or reported improvement in Patient Global Impression of Change); (2) exercise capacity (≥0.5 mL/kg per min in peak oxygen uptake); (3) >10% decrease in left atrial volume index; (4) >10% improvement in septal early diastolic mitral annular velocity (e'); (5) ≥50% reduction in NT-proBNP (N-terminal pro-B-type natriuretic peptide). Overall clinical response was classified by the number of favorable outcomes achieved: nonresponder (none), limited (1 or 2), partial (3 or 4), or complete (all 5).</p><p><strong>Results: </strong>At 36 weeks, a greater proportion of patients treated with aficamten versus placebo experienced improvements in symptom burden (71% versus 53%), peak exercise capacity (45% versus 37%), left atrial volume index (31% versus 23%), septal e' (51% versus 26%), and NT-proBNP (63% versus 5%) (<i>P</i><0.05 for all except peak oxygen uptake, <i>P</i>=0.1). Number needed to treat for aficamten ranged from 1.7 (NT-proBNP reduction) to 14 (peak oxygen uptake improvement) relative to placebo. A partial or complete clinical response (≥3 outcomes) was achieved in 53% of patients on aficamten versus 14% on placebo (<i>P</i><0.001).</p><p><strong>Conclusions: </strong>In patients with nHCM, aficamten was associated with improvements across a broad range of clinically relevant measures including symptom burden and diastolic function. These results underscore a potential benefit of aficamten in the population of patients with nHCM.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT06081894.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"1547-1559"},"PeriodicalIF":41.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structure-Function Relationship as the Foundation for Cardiac Myosin Inhibition in Hypertrophic Cardiomyopathy.","authors":"Masataka Kawana, Kathleen M Ruppel, James A Spudich","doi":"10.1161/CIRCULATIONAHA.126.082644","DOIUrl":"10.1161/CIRCULATIONAHA.126.082644","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"1646-1648"},"PeriodicalIF":41.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Aficamten on Cardiac Structure and Function in Patients With Symptomatic Nonobstructive Hypertrophic Cardiomyopathy.","authors":"Sheila M Hegde, Xiaowen Wang, Ankit Bhatia, Maria Luisa Peña-Peña, Mark V Sherrid, Estevao Lanna Figueiredo, Michael Arad, Roberto Barriales-Villa, Lubna Choudhury, Brian L Claggett, Caroline J Coats, Edileide de Barros Correia, Juan Pablo Costabel, Perry M Elliott, Jorge E Silva Enciso, Pablo Garcia-Pavia, Junbo Ge, Carolyn Y Ho, Neal K Lakdawala, Gregory D Lewis, Martin S Maron, Matthew W Martinez, Ahmad Masri, Mathew S Maurer, Michelle Michels, Sumeet S Mitter, Jesus E Pino Moreno, Viktória Nagy, Iacopo Olivotto, Anjali T Owens, Steen H Poulsen, Florian Rader, Ethan J Rowin, Maria Ruda, P Christian Schulze, Nikhil Sikand, John A Spertus, Xiaoyan Zhao, Punag H Divanji, Stephen B Heitner, Daniel L Jacoby, Stuart Kupfer, Fady I Malik, Joel Salazar-Mendiguchía, Amy Wohltman, Shu Zhuo, Scott D Solomon","doi":"10.1161/CIRCULATIONAHA.126.082343","DOIUrl":"10.1161/CIRCULATIONAHA.126.082343","url":null,"abstract":"<p><strong>Background: </strong>Aficamten significantly improved both functional capacity and patient-reported health status in patients with symptomatic nonobstructive hypertrophic cardiomyopathy in the phase 3 randomized, placebo-controlled ACACIA-HCM trial (Assessment Comparing Aficamten to Placebo on Cardiac Endpoints in Adults with Non-Obstructive HCM; NCT06081894). Serial echocardiographic examinations may provide insights into the mechanisms underlying the therapeutic effect of aficamten in this prespecified exploratory analysis.</p><p><strong>Methods: </strong>Symptomatic patients with nonobstructive hypertrophic cardiomyopathy were randomized 1:1 to receive aficamten (range, 5-20 mg, titration based on left ventricular [LV] ejection fraction) or placebo for up to 72 weeks (end of treatment). The effect of aficamten on echocardiographic measures at 36 weeks (time of primary end point) and end of treatment was assessed with linear regression models adjusted for baseline values, intracavity obstruction, and baseline atrial fibrillation.</p><p><strong>Results: </strong>Among 517 participants (mean±SD: age, 55±16 years; 54% female, 75% White, 13% Asian), mean baseline LV ejection fraction was 68±4% with abnormal measures of diastolic function. Compared with placebo, aficamten decreased LV ejection fraction (-4.6% [-5.5, -3.6]; <i>P</i><0.001) at 36 weeks and increased LV volumes. Aficamten improved measures of diastolic function, including lateral e' and septal e' velocities, at 36 weeks (0.9 cm/s [0.6, 1.2] and 0.7 cm/s [0.4, 0.9], respectively; <i>P</i><0.001 for both) and at end of treatment (0.9 cm/s [0.5, 1.2] and 0.9 cm/s [0.6, 1.1], respectively; <i>P</i><0.001 for both) and septal E/e' by end of treatment (-1.4 [-2.1, -0.6]; <i>P</i><0.001, respectively). Peak tricuspid regurgitation velocity improved at 36 weeks (-10.4 cm/s [-19.9, -1.0]; <i>P</i>=0.030) with a sustained effect through end of treatment. Left atrial volume index did not significantly improve at 36 weeks (-1.3 [95% CI, -2.6, 0.04]; <i>P</i>=0.06) but showed a trend towards improvement with longer treatment exposure (-1.7 [-3.2, -0.3]; <i>P</i>=0.022). Aficamten demonstrated incremental improvements in measures of LV structure and function compared to placebo as doses were increased, with improvement in diastolic indices evident by week 2 of titration.</p><p><strong>Conclusions: </strong>In patients with nonobstructive hypertrophic cardiomyopathy, aficamten improved echocardiographic measures of diastolic function. These findings suggest that the benefits of aficamten extend beyond the effects of LV outflow tract gradient reduction observed in prior studies.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT06081894.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"1563-1576"},"PeriodicalIF":41.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship is the Intervention: Listening to Adults With Congenital Heart Disease.","authors":"Anushree Agarwal, Joseph Valente, Lindsay Alano","doi":"10.1161/CIRCULATIONAHA.126.082725","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.082725","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"154 16","pages":"1543-1544"},"PeriodicalIF":41.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ICare-FASTER (Improving Care by Faster Risk Stratification Through Use of High-Sensitivity Point-of-Care Troponin in Patients Presenting With Possible Acute Coronary Syndrome in the Emergency Department): A Stepped-Wedge Cluster-Randomized Trial.","authors":"Martin Than, John W Pickering, Laura R Joyce, Vanessa Buchan, Christopher M Florkowski, Nicholas L Mills, Laura Hamill, Jason Prystowsky, Simon Harger, Mary Reed, Jared Bayless, Alexander Feberwee, Tamsin Attenburrow, Timothy Norman, Oliver Welfare, Tamika Heiden, Peter Kavsak, Allan S Jaffe, Fred S Apple, W Frank Peacock, Louise Cullen, Sally Aldous, A Mark Richards, Cameron Lacey, Richard Troughton, Christopher Frampton, Richard Body, Christian Müeller, Sarah Lord, Peter M George, Gerard Devlin","doi":"10.1161/CIRCULATIONAHA.126.080866","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.080866","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care high-sensitivity cTn (cardiac troponin; hs-cTn) testing has the potential to expedite decision-making and reduce emergency department (ED) length of stay for patients presenting with possible myocardial infarction by ensuring that results are consistently available when sought by clinicians. We assessed the real-life effectiveness and safety of implementing point-of-care hs-cTn testing in the ED.</p><p><strong>Methods: </strong>We conducted a pragmatic, stepped-wedge cluster-randomized trial. The control arm was usual care with an accelerated diagnostic pathway using a single-sample rule-out step with a central laboratory hs-cTn assay. The intervention arm used the same pathway with a point-of-care hs-cTnI assay. The primary effectiveness outcome was ED length of stay assessed using a generalized linear mixed model. The safety outcome was myocardial infarction or cardiac death within 30 days.</p><p><strong>Results: </strong>Six sites participated, with 59 980 ED presentations (44 747 individuals; mean 61±19 years of age; 49.5% female) from February 2023 through January 2025; 31 392 presentations were during the intervention arm. After adjustment for covariates associated with length of stay, the intervention reduced length of stay by 13% (95% CI, 9%-16%; <i>P</i><0.001), corresponding to a reduction of 47 minutes (95% CI, 33-61 minutes) from a mean length of stay in the control arm of 376 minutes. The 30-day myocardial infarction or cardiac death rate was similar in the control and intervention arms (0.39% and 0.39%, respectively; <i>P</i>=0.54).</p><p><strong>Conclusions: </strong>Implementation of whole-blood hs-cTnI testing at the point of care into an accelerated diagnostic pathway was safe and reduced length of stay in the ED compared with laboratory testing.</p><p><strong>Registration: </strong>URL: https://www.anzctr.org.au; Unique identifier: ACTRN12619001189112.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":41.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}