Limit of detection of troponin discharge strategy versus usual care: randomised controlled trial.
Acute Coronary Syndrome
/ blood
Adult
Aged
Angina Pectoris
/ blood
Biomarkers
/ blood
Cardiology Service, Hospital
Clinical Decision Rules
Electrocardiography
Emergency Service, Hospital
Female
Humans
Length of Stay
Male
Middle Aged
Patient Discharge
Predictive Value of Tests
Prospective Studies
Risk Assessment
Risk Factors
Time Factors
Troponin
/ blood
United Kingdom
acute coronary syndromes
acute myocardial infarction
health care delivery
health care economics
quality and outcomes of care
Journal
Heart (British Cardiac Society)
ISSN: 1468-201X
Titre abrégé: Heart
Pays: England
ID NLM: 9602087
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
05
02
2020
revised:
27
03
2020
accepted:
30
03
2020
pubmed:
7
5
2020
medline:
29
6
2021
entrez:
7
5
2020
Statut:
ppublish
Résumé
The clinical effectiveness of a 'rule-out' acute coronary syndrome (ACS) strategy for emergency department patients with chest pain, incorporating a single undetectable high-sensitivity cardiac troponin (hs-cTn) taken at presentation, together with a non-ischaemic ECG, remains unknown. A randomised controlled trial, across eight hospitals in the UK, aimed to establish the clinical effectiveness of an undetectable hs-cTn and ECG (limit of detection and ECG discharge (LoDED)) discharge strategy. Eligible adult patients presented with chest pain; the treating clinician intended to perform investigations to rule out an ACS; the initial ECG was non-ischaemic; and peak symptoms occurred <6 hours previously. Participants were randomised 1:1 to either the LoDED strategy or the usual rule-out strategy. The primary outcome was discharge from the hospital within 4 hours of arrival, without a major adverse cardiac event (MACE) within 30 days. Between June 2018 and March 2019, 632 patients were randomised; 3 were later withdrawn. Of 629 patients (age 53.8 (SD 16.1) years, 41% women), 7% had a MACE within 30 days. For the LoDED strategy, 141 of 309 (46%) patients were discharged within 4 hours, without MACE within 30 days, and for usual care, 114 of 311 (37%); pooled adjusted OR 1.58 (95% CI 0.84 to 2.98). No patient with an initial undetectable hs-cTn had a MACE within 30 days. The LoDED strategy facilitates safe early discharge in >40% of patients with chest pain. Clinical effectiveness is variable when compared with existing rule-out strategies and influenced by wider system factors. ISRCTN86184521.
Identifiants
pubmed: 32371401
pii: heartjnl-2020-316692
doi: 10.1136/heartjnl-2020-316692
pmc: PMC7525793
doi:
Substances chimiques
Biomarkers
0
Troponin
0
Banques de données
ISRCTN
['ISRCTN86184521']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1586-1594Subventions
Organisme : Department of Health
ID : PB-PG-0416-20012
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: EC has received funding from Abbott Diagnostics for related research and honoraria for education from Roche.
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