A Randomized Trial of a 1-Hour Troponin T Protocol in Suspected Acute Coronary Syndromes
| Autor: | Erin Morton, Anthony Chuang, Jonathan Karnon, Matthew Horsfall, Stephen Quinn, Louise Cullen, Andrew Blyth, Adam J. Nelson, Kristina Lambrakis, Cynthia Papendick, Anil Seshadri, Derek P. Chew, John K. French, Michael J.R. Edmonds, Deborah Wright, Tom Briffa |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Acute coronary syndrome Time Factors Myocardial Infarction Chest pain Workflow law.invention Troponin T Randomized controlled trial Predictive Value of Tests Risk Factors law Cause of Death Physiology (medical) Internal medicine medicine Humans Prospective Studies Myocardial infarction Acute Coronary Syndrome Aged biology business.industry Australia Emergency department Middle Aged Prognosis medicine.disease Troponin Clinical trial Cardiology biology.protein Female Cardiology Service Hospital medicine.symptom Emergency Service Hospital Cardiology and Cardiovascular Medicine business Biomarkers |
| Zdroj: | Circulation. 140:1543-1556 |
| ISSN: | 1524-4539 0009-7322 |
| Popis: | Background: High-sensitivity troponin assays promise earlier discrimination of myocardial infarction. Yet, the benefits and harms of this improved discriminatory performance when incorporated within rapid testing protocols, with respect to subsequent testing and clinical events, has not been evaluated in an in-practice patient-level randomized study. This multicenter study evaluated the noninferiority of a 0/1-hour high-sensitivity cardiac troponin T (hs-cTnT) protocol in comparison with a 0/3-hour masked hs-cTnT protocol in patients with suspected acute coronary syndrome presenting to the emergency department (ED). Methods: Patients were randomly assigned to either a 0/1-hour hs-cTnT protocol (reported to the limit of detection [ Results: In total, 3378 participants with an emergency presentation were randomly assigned between August 2015 and April 2019. Ninety participants were deemed ineligible or withdrew consent. The remaining participants received care guided either by the 0/1-hour hs-cTnT protocol (n=1646) or the 0/3-hour standard masked hs-cTnT protocol (n=1642) and were followed for 30 days. Median age was 59 (49–70) years, and 47% were female. Participants in the 0/1-hour arm were more likely to be discharged from the ED (0/1-hour arm: 45.1% versus standard arm: 32.3%, P P P P value=0.001, superiority P value=0.744), although an increase in myocardial injury was observed. Among patients discharged from ED, the 0/1-hour protocol had a negative predictive value of 99.6% (95% CI, 99.0–99.9%) for 30-day death or myocardial infarction. Conclusions: This in-practice evaluation of a 0/1-hour hs-cTnT protocol embedded in ED care enabled more rapid discharge of patients with suspected acute coronary syndrome. Improving short-term outcomes among patients with newly recognized troponin T elevation will require an evolution in management strategies for these patients. Clinical Trial Registration: URL: https://www.anzctr.org.au . Unique identifier: ACTRN12615001379505. |
| Databáze: | OpenAIRE |
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