Single high-sensitivity troponin levels to assess patients with potential acute coronary syndromes. Issue 9 (12th January 2021)

• Record Type: Journal Article
• Authors: Barnes, Cara; Fatovich, Daniel M; Macdonald, Stephen P J; Alcock, Richard F; Spiro, Jon R; Briffa, Tom G; Schultz, Carl J; Hillis, Graham S
• Is Part Of: Heart. Volume 107:Issue 9(2021)
• Page Start: 721
• Page End: 727
• Publication Date: 2021-01-12
• Subjects: acute coronary syndromes -- health care delivery -- quality and outcomes of care; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2020-317997
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: We tested the hypothesis that patients with a potential acute coronary syndrome (ACS) and very low levels of high-sensitivity cardiac troponin I can be efficiently and safely discharged from the emergency department after a single troponin measurement. Methods: This prospective cohort study recruited 2255 consecutive patients aged ≥18 years presenting to the Emergency Department, Royal Perth Hospital, Western Australia, with chest pain without high-risk features but requiring the exclusion of ACS. Patients were managed using a guideline-recommended pathway or our novel Single Troponin Accelerated Triage (STAT) pathway. The primary outcome was the percentage of patients discharged in <3 hours. Secondary outcomes included the duration of observation and death or acute myocardial infarction in the next 30 days. Results: The study enrolled 1131 patients to the standard cohort and 1124 to the STAT cohort. Thirty-eight per cent of the standard cohort were discharged directly from emergency department compared with 63% of the STAT cohort (p<0.001). The median duration of observation was 4.3 (IQR 3.3–7.1) hours in the standard cohort and 3.6 (2.6–5.4) hours in the STAT cohort (p<0.001), with 21% and 38% discharged in <3 hours, respectively (p<0.001). No patients discharged directly from the emergency department died or suffered an acute myocardial infarction within 30 days in either cohort. Conclusions: Among low-risk patients with a potential ACS, a pathway which incorporates early discharge based on a single very low level of high-sensitivity cardiac troponin increases the proportion of patients discharged directly from the emergency department, reduces length of stay and is safe. Trial registration number: ACTRN12618000797279.