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Limit of detection of troponin discharge strategy versus usual care : randomised controlled trial
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Carlton, Edward Watts, Ingram, Jenny, Taylor, Hazel, Glynn, Joel, Kandiyali, Rebecca, Campbell, Sarah, Beasant, Lucy, Aziz, Shahid, Beresford, Peter, Kendall, Jason, Reuben, Adam, Smith, Jason E, Chapman, Rebecca, Creanor, Siobhan and Benger, Jonathan Richard (2020) Limit of detection of troponin discharge strategy versus usual care : randomised controlled trial. Heart, 106 (20). pp. 1586-1594. doi:10.1136/heartjnl-2020-316692 ISSN 1355-6037.
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WRAP-limit-detection-troponin-discharge-strategy-versus-usual-care-randomised-controlled-trial-2021.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons: Attribution-Noncommercial 4.0. Download (1195Kb) | Preview |
Official URL: http://dx.doi.org/10.1136/heartjnl-2020-316692
Abstract
Introduction: 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.
Methods: 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.
Results: Between June 2018 and March 2019, 632 patients were randomised; 3 were later withdrawn.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.
Conclusion: 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.
| Item Type: | Journal Article | ||||||||
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| Subjects: | Q Science > QH Natural history R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Coronary heart disease -- Diagnosis, Emergency medical services -- Patients, Chest pain, Point-of-care testing, Troponin I | ||||||||
| Journal or Publication Title: | Heart | ||||||||
| Publisher: | BMJ | ||||||||
| ISSN: | 1355-6037 | ||||||||
| Official Date: | 25 September 2020 | ||||||||
| Dates: |
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| Volume: | 106 | ||||||||
| Number: | 20 | ||||||||
| Page Range: | pp. 1586-1594 | ||||||||
| DOI: | 10.1136/heartjnl-2020-316692 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||
| Date of first compliant deposit: | 25 October 2021 | ||||||||
| Date of first compliant Open Access: | 25 October 2021 | ||||||||
| RIOXX Funder/Project Grant: |
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| Is Part Of: | 1 |
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