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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; Benger, Jonathan Richard

Limit of detection of troponin discharge strategy versus usual care: randomised controlled trial

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  • Medientyp: E-Artikel
  • Titel: Limit of detection of troponin discharge strategy versus usual care: randomised controlled trial
  • Beteiligte: 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; Benger, Jonathan Richard
  • Erschienen: BMJ, 2020
  • Erschienen in: Heart, 106 (2020) 20, Seite 1586-1594
  • Sprache: Englisch
  • DOI: 10.1136/heartjnl-2020-316692
  • ISSN: 1468-201X; 1355-6037
  • Schlagwörter: Cardiology and Cardiovascular Medicine
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:sec><jats:title>Introduction</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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 &lt;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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Between June 2018 and March 2019, 632 patients were randomised; 3 were later withdrawn.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.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The LoDED strategy facilitates safe early discharge in &gt;40% of patients with chest pain. Clinical effectiveness is variable when compared with existing rule-out strategies and influenced by wider system factors.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="ISRCTN86184521">ISRCTN86184521</jats:ext-link>.</jats:p></jats:sec>