A 0-Hour/1-Hour Protocol for Safe, Early Discharge of Chest Pain Patients

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
Arash MokhtariUlf Ekelund

Abstract

Guidelines recommend a 0-hour/1-hour high-sensitivity cardiac troponin T (hs-cTnT) diagnostic strategy in acute chest pain patients. There are, however, little data on the performance of this strategy when combined with clinical risk stratification. We aimed to evaluate the diagnostic accuracy of an accelerated diagnostic protocol (ADP) using the 0-hour/1-hour hs-cTnT strategy together with an adapted Thrombolysis In Myocardial Infarction (TIMI) score and electrocardiogram (ECG) for ruling out major adverse cardiac events (MACE) within 30 days. This prospective observational study enrolled consecutive emergency department (ED) chest pain patients. TIMI score variables, ED physicians' assessments of the ECG, and 0- and 1-hour hs-cTnT were collected. Thirty-day MACE was defined as acute myocardial infarction (AMI), unstable angina (UA), cardiogenic shock, ventricular arrhythmia, atrioventricular block, cardiac arrest, or death of cardiac or unknown cause. A total of 1,020 patients were included in the final analysis. The combination of an adapted TIMI score ≤1, a nonischemic ECG, and either a 0-hour hs-cTnT < 5 ng/L or a 0-hour hs-cTnT < 12 ng/L combined with a 1-hour increase < 3 ng/L identified 432 (42.4%) patients as very low ...Continue Reading

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Citations

Dec 10, 2019·Scandinavian Cardiovascular Journal : SCJ·Ardavan KhoshnoodArash Mokhtari
Apr 27, 2018·The American Journal of Emergency Medicine·Shane M SummersCurtis J Hunter
Mar 30, 2021·Journal of the American College of Emergency Physicians Open·Anders BjörkelundJonas Björk
Jul 2, 2021·European Heart Journal. Acute Cardiovascular Care·Ehsan KhanDerek P Chew
Jul 7, 2021·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Paul I MuseyChristopher R Carpenter
Jan 4, 2022·European Heart Journal. Acute Cardiovascular Care·Andreas RoosMartin J Holzmann

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