Sandeman, Dennis; Syed, Maaz BJ; Kimenai, Dorien M; Lee, Kuan Ken; Anand, Atul; Joshi, Shruti S; Dinnel, Lorraine; Wenham, Philip R; Campbell, Ken; Jarvie, Mary; +12 more... Galloway, Donna; Anderson, Mhairi; Roy, Bappa; Andrews, Jack PM; Strachan, Fiona E; Ferry, Amy V; Chapman, Andrew R; Elsby, Sarah; Francis, Mark; Cargill, Robert; Shah, Anoop SV; Mills, Nicholas L; (2021) Implementation of an early rule-out pathway for myocardial infarction using a high-sensitivity cardiac troponin T assay. Open heart, 8 (2). e001769-e001769. ISSN 2053-3624 DOI: https://doi.org/10.1136/openhrt-2021-001769
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Abstract
OBJECTIVES: Patients with suspected acute coronary syndrome and high-sensitivity cardiac troponin (hs-cTn) concentrations below the limit of detection at presentation are low risk. We aim to determine whether implementing this approach facilitates the safe early discharge of patients. METHODS: In a prospective single-centre cohort study, consecutive patients with suspected acute coronary syndrome were included before (standard care) and after (intervention) implementation of an early rule-out pathway. During standard care, myocardial infarction was ruled out if hs-cTnT concentrations were <99th centile (14 ng/L) at presentation and at 6-12 hours after symptom onset. In the intervention, patients were ruled out if hs-cTnT concentrations were <5 ng/L at presentation and symptoms present for ≥3 hours or were ≥5 ng/L and unchanged within the reference range at 3 hours. We compared duration of stay (efficacy) and all-cause death at 1 year (safety) before and after implementation. RESULTS: We included 10 315 consecutive patients (64±16 years, 46% women) with 6642 (64%) and 3673 (36%) in the standard care and intervention groups, respectively. Duration of stay was reduced from 534 (IQR, 220-2279) to 390 (IQR, 218-1910) min (p<0.001) after implementation. At 1 year, all-cause death occurred in 10.9% (721 of 6642) and 10.4% (381 of 3673) of patients in the standard care group (referent) and intervention group, respectively (adjusted OR 1.02, 95% CI 0.88 to 1.18). CONCLUSION: In patients with suspected acute coronary syndrome, implementing an early rule-out pathway using hs-cTnT concentrations <5 ng/L at presentation reduced the duration of stay in hospital without compromising safety.
Item Type | Article |
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Faculty and Department | Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology |
PubMed ID | 34824100 |
Elements ID | 168675 |