A 0‐Hour/1‐Hour Protocol for Safe, Early Discharge of Chest Pain Patients

Mokhtari, Arash; Lindahl, Bertil; Schiopu, Alexandru; Yndigegn, Troels; Khoshnood, Ardavan; Gilje, Patrik; Ekelund, Ulf

doi:10.1111/acem.13224

Cited by 30 publications

(17 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Regarding the rule-out algorithms using LoD at H0 [2] , our study confirms that this strategy gives the highest sensitivity and a high NPV for HS-assays and some other assays (cTnI-Pathfast, cTnI-Access, cTnI-Ultra). Our results are similar to those of the literature [17] , [18] , [19] , [20] , [21] , [22] , [23] . However, we question the safety of this algorithm for ruling-out NSTEMI in routine practice because the analytical reliability of the LoD as a cut-off is vulnerable to variation [24] , [25] , [26] .…”

Section: Discussionsupporting

confidence: 93%

Multi-centre evaluation of recent troponin assays for the diagnosis of NSTEMI

Chenevier‐Gobeaux

Deweerdt

Renaud

et al. 2018

Practical Laboratory Medicine

View full text Add to dashboard Cite

ObjectivesWe aimed to compare the use of nine different cardiac troponin (cTn) assays (2 cTnT and 7 cTnI) for the diagnosis of NSTEMI in a single multi-centre population.Design and methodsOne hundred and fifty-eight patients were included (mean age 60 years, SD 17 years), including 23 patients (14%) with NSTEMI.ResultsThe analytical comparison highlighted a large heterogeneity of cTn assays, as reflected by percentages of patients with detectable cTn, correlation coefficients, Passing-Bablok comparisons and concordance coefficients. Correlations within cTnI assays were good and correlation within cTnT assays was excellent. Diagnostic performances demonstrated that each cTn assay has specific threshold values. Furthermore, some assays (HS-cTnI and T, cTnI-Pathfast and cTnI-Centaur) indicated high sensitivity and negative predictive value using the limit of detection (LoD) diagnostic strategy. For the latter assays, a significant increase in specificity was found when using the 99th percentile or the H0-H3 strategies, in comparison to the LoD strategy. When applying the European Society of Cardiology H0-H3 algorithm, comparable diagnostic performances were obtained.ConclusionAll 9 cTn assays indicated overall good diagnostic performances for the diagnosis of NSTEMI in emergency departments when the recommended algorithm based on the variation of cTn value between two measurements at admission and 3 h later was used.

show abstract

Section: Discussionsupporting

confidence: 93%

Multi-centre evaluation of recent troponin assays for the diagnosis of NSTEMI

Chenevier‐Gobeaux

Deweerdt

Renaud

et al. 2018

Practical Laboratory Medicine

View full text Add to dashboard Cite

show abstract

“…The ESC-TROP trial is the first to analyze the performance and applicability of the ESC recommended 0-/ 1-h hs-cTnT protocol in routine care, supplemented with clinical assessment and ECG. Even though the 0-/1-h hs-cTnT protocol has been validated in different settings, prior studies have primarily been observational, and patients have not been managed in accordance with the protocol [5,17]. Since the true safety and effectiveness of the protocol in routine care is thereby unknown, many physicians have hesitated to implement the protocol in routine care.…”

Section: Discussionmentioning

confidence: 99%

“…Third, the ESC protocol does not specify how to identify the low risk patients who should undergo further objective testing in order to exclude UA. Our previous studies indicate that 0-/1-h hs-cTnT combined with clinical risk stratification can identify patients with such a low risk of 30-day MACE including UA [5, 6, 17] that neither admission nor further cardiac testing is needed. Thus, there is a clear need for further studies on the performance of 0-/1-h hs-cTnT testing in routine care.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and Safety of the European Society of Cardiology 0-/1-h Troponin Rule-Out Protocol: The Design of the ESC-TROP Multicenter Implementation Study

et al. 2020

Self Cite

View full text Add to dashboard Cite

Chest pain is one of the most common complaints at the emergency department (ED), and it is commonly the perceived likelihood of acute coronary syndrome (ACS) that drives management. Guidelines from the European Society of Cardiology (ESC) recommend the use of a 0-/1-h high-sensitivity cardiac troponin T (hs-cTnT) protocol to rule out or in ACS, but this is mostly based on observational studies. The aim of the ESC-TROP trial is to determine the safety and effectiveness of the ESC 0-/1-h hs-cTnT protocol when implemented in routine care. Adult chest pain patients at 5 EDs in the Skåne Region, Sweden, are included in the trial. The 0-/1-h hs-cTnT ESC protocol supplemented with clinical assessment and electrocardiography (ECG) is implemented at 3 EDs, and the other 2 EDs act as concurrent controls. Outcomes will be evaluated during the 10 months after the implementation and the corresponding 10 months of the previous year. The 2 co-primary outcomes are (a) acute myocardial infarction (AMI) and all-cause death within 30 days in patients discharged from the ED, and (b) ED length of stay of the same patients. Secondary outcomes include the proportion of chest pain patients discharged from the ED and the number of ruled-out patients undergoing objective testing within 30 days. The ESC-TROP trial will determine the performance and applicability of the 0-/1-h hs-cTnT ESC protocol supplemented with clinical assessment and ECG when implemented in routine ED care. It will provide evidence whether 0-/1-h hs-cTnT testing is safe, effective, and feasible, and whether widespread implementation as recommended by ESC guidelines should be supported.

show abstract

“…While several studies have evaluated the prognostic value of troponin for the prediction of 30-day MACE, (17)(18)(19)(20) the data on its use for predicting one-year MACE is not as well established. In our study population, elevated levels of hsTnT were powerfully predictive of MACE up to one year after the index event.…”

Section: Discussionmentioning

confidence: 99%

High-sensitivity troponin T and long-term adverse cardiac events among patients presenting with suspected acute coronary syndrome in Singapore

Lin

Lim

Sjt

et al. 2019

smedj

View full text Add to dashboard Cite

Prognostic thresholds for 30-day major adverse cardiac events (MACE) have been studied for highsensitivity troponin T (hsTnT) in patients with suspected acute coronary syndrome (ACS), but there is limited data on the prognostic performance of hsTnT for one-year MACE. METHODS We prospectively measured hsTnT (in ng/mL up to two decimal places) at 0, 2 and 7 hours for patients presenting with symptoms suggestive of ACS to our emergency department from March 2010 to April 2013. We assessed the prognostic performance of hsTnT cutoffs for 30-day and one-year MACE, and the utility of delta-hsTnT in predicting MACE. RESULTS Among 2,444 patients studied, 273 (11.2%) developed MACE (including index MACE) by 30 days and 359

show abstract

A 0‐Hour/1‐Hour Protocol for Safe, Early Discharge of Chest Pain Patients

Abstract: An ADP using the guideline recommended 0-hour/1-hour hs-cTnT strategy rapidly identified patients with a very low risk of 30-day MACE including UA where no further cardiac testing would be needed. This could potentially allow safe early discharge of about 40% of ED chest pain patients.

Cited by 30 publications

References 47 publications

Multi-centre evaluation of recent troponin assays for the diagnosis of NSTEMI

Multi-centre evaluation of recent troponin assays for the diagnosis of NSTEMI

Effectiveness and Safety of the European Society of Cardiology 0-/1-h Troponin Rule-Out Protocol: The Design of the ESC-TROP Multicenter Implementation Study

High-sensitivity troponin T and long-term adverse cardiac events among patients presenting with suspected acute coronary syndrome in Singapore

Contact Info

Product

Resources

About