Guideline-conforming timing of invasive management in troponin-positive or high-risk ACS without persistent ST-segment elevation in German chest pain units

Breuckmann, Frank; Remberg, Friederike; Böse, Dirk; Lichtenberg, Michael; Kümpers, Philipp; Pavenstädt, Hermann-Joseph; Waltenberger, Johannes; Fischer, Dieter

doi:10.1007/s00059-015-4354-8

Cited by 7 publications

(5 citation statements)

References 29 publications

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“…According to our data, even though there was a significant difference in the frequency of recommended bypass graft surgery which may be due to the assumption that university hospitals provide superior background and frequency in performing complex interventions, in general, rates of interventions were high, comparable between both sites, independent from the accuracy of the rapid rule-out protocol and the time of first relevant cTn delta as well as comparable to larger recent trials (i.e. ACUITY and PLATO) [ 37 – 39 ].…”

Section: Discussionmentioning

confidence: 55%

How rapid is rapid? Exemplary results of real-life rapid rule-out troponin timing in troponin-positive acute coronary syndromes without persistent ST-segment elevation in two contrasting German chest pain unit facilities

et al. 2016

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AimTo analyse the timing of cardiac troponin (cTn) measurements in high-risk and cTn-positive acute coronary syndromes without persistent ST-segment elevation (NSTE-ACS) in two structurally different German chest pain units (CPUs), contrasting an urban university maximum care and a rural regional primary care facility.MethodsAll patients encoded as NSTEMI during the year 2013 were retrospectively enrolled in two centres: site (I)—centre of maximum care in an urban university setting and site (II)—centre of primary care in a rural regional care setting. Data acquisition included time intervals from admission to baseline cTn and first and second cTn control as well as type and timing of invasive management.ResultsThe median times (site I vs. site II) from admission to cTn result announcement were 26.5 vs. 33.0 min (p = 0.02) for baseline, 4 vs. 4 h (p = 0.43) for the first and 11.0 vs. 16.5 h (p = 0.03) for the second control. Timely announcement, as recommended by guidelines, was available in 86.9 % at baseline, 59.4 % for the first or 41.1 % for the second cTn control. Rates and timing of invasive management were independent from the time point of positive cTn announcement (p = 0.51 and p = 0.68, respectively).ConclusionsGerman CPUs provide timely identification of cTn-positive patients in a narrow and guideline-adherent time frame using a rapid rule-out protocol. Especially, baseline and early cTn timing was comparable between the urban university maximum care and the rural regional primary care facility without relevant impact on guideline-conforming invasive management, underlining the high standard of care in those highly professional institutions.

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Section: Discussionmentioning

confidence: 55%

How rapid is rapid? Exemplary results of real-life rapid rule-out troponin timing in troponin-positive acute coronary syndromes without persistent ST-segment elevation in two contrasting German chest pain unit facilities

et al. 2016

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“…Controversially, previous data from the CPU registry demonstrated, on the one hand, that troponin-positive CPU patients were more rapidly and more often treated with PCI than were troponinnegative patients, which was associated with a lower death rate, but on the other hand that there was also a low adherence to the standard of care as proposed by the ESC guidelines, although background data were not provided [23,24]. Recently, we were able to demonstrate guidelineadherent timing of invasive therapy for NSTEMI and hr-NSTE-ACS inup to85 % ofthe CPUpatients intwoexemplarysites [9]. Especially those patients at very high risk received guideline-adherent timing of coronary angiography in over 90 % of cases.…”

Section: On-versus Off-hour Care For Patients With Non-st-segment Elementioning

confidence: 96%

“…However, most studies focused on patients suffering from ACS with persistent STsegment elevation myocardial infarction (STEMI) only. There are limited data available comparing on-and off-hour care in CPUs or accredited chest pain centers independent of STEMI [9]. The aim of the current study was to analyze differences in guideline-adherent timing of PCI between on-and off-hour care for patients with myocardial infarction D. Fischer and T. Rassaf contributed equally and are joint senior authors.…”

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confidence: 99%

On- versus off-hour care for patients with non-ST-segment elevation myocardial infarction in Germany

Breuckmann

Remberg

Böse

et al. 2016

Herz

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“…75,3 %. Die Einhaltung der Empfehlungen zur medizinischen Therapie war hoch und zwischen beiden Standorten vergleichbar [25].…”

Section: Chest-pain-unit-betreuung Zu Verschiedenen Zeitenunclassified

Chest Pain Unit: aktueller Stand und Entwicklungen

Buerke,

Janusch,

Dimitrov

et al. 2023

Aktuelle Kardiologie

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ZusammenfassungThorakale Schmerzen sind eine der häufigsten Ursachen für die Vorstellung von Patienten beim Notdienst und in der zentralen Notaufnahme. Bei kardialen Ursachen müssen die Patienten häufig stationär aufgenommen werden. In der kardiovaskulären Notfallmedizin ist es wichtig, dass der Notfallmediziner Patienten entsprechend einordnet und das Risikoprofil der Patienten erfasst, da ca. 10–30% der Fälle mit thorakalen Beschwerden ein akutes Koronarsyndrom (ACS) haben. Das Elektrokardiogramm und die Werte des hochsensitiven (hs) Troponins bei Aufnahme und im Verlauf nach 1 h und/oder 2 h sind für die Diagnose eines Myokardinfarkts zwingend erforderlich. Dies kann in Chest Pain Units (CPU), in der Notaufnahme oder separat standardisiert durchgeführt werden. Bei konventioneller Versorgung (ohne CPU-SOP) besteht ein nicht zu vernachlässigendes Risiko, dass 2–10% der Anginapatienten mit (sub-)akutem Myokardinfarkt fälschlicherweise nach Hause entlassen werden. Diese unzureichende Versorgung der ACS-Patienten geht mit langfristig erhöhten Kosten und dem Risiko einer Klage wegen fahrlässiger medizinischer Behandlung einher. Die Chest Pain Units (CPU) wurden vor ca. 2 Jahrzehnten in der Notfallversorgung in Deutschland eingeführt. Ziel war es, die Versorgung der Patienten zu verbessern, bei den Ärzten mehr Aufmerksamkeit zu erreichen, die Anzahl unnötiger Aufnahmen und Eingriffe zu reduzieren und dadurch die entstehenden Kosten zu senken. Dieses Ziel wird durch die Verwendung von Diagnoseprotokollen, Zeitvorgaben zur Versorgung, standardisierte Abläufe auch für Patienten mit thorakalen Beschwerden und anderen Diagnosen, vereinheitlichte Therapien und qualifizierte CPU-Mitarbeitern realisiert.

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Guideline-conforming timing of invasive management in troponin-positive or high-risk ACS without persistent ST-segment elevation in German chest pain units

Cited by 7 publications

References 29 publications

How rapid is rapid? Exemplary results of real-life rapid rule-out troponin timing in troponin-positive acute coronary syndromes without persistent ST-segment elevation in two contrasting German chest pain unit facilities

How rapid is rapid? Exemplary results of real-life rapid rule-out troponin timing in troponin-positive acute coronary syndromes without persistent ST-segment elevation in two contrasting German chest pain unit facilities

On- versus off-hour care for patients with non-ST-segment elevation myocardial infarction in Germany

Chest Pain Unit: aktueller Stand und Entwicklungen

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