A direct comparison of decision rules for early discharge of suspected acute coronary syndromes in the era of high sensitivity troponin

European Heart Journal. Acute Cardiovascular Care
Pei Gee ChewAleem Khand

Abstract

We tested the hypothesis that a single high sensitivity troponin at limits of detection (LOD HSTnT) (<5 ng/l) combined with a presentation non-ischaemic electrocardiogram is superior to low-risk Global Registry of Acute Coronary Events (GRACE) (<75), Thrombolysis in Myocardial Infarction (TIMI) (≤1) and History, ECG, Age, Risk factors and Troponin (HEART) score (≤3) as an aid to early, safe discharge for suspected acute coronary syndrome. In a prospective cohort study, risk scores were computed in consecutive patients with suspected acute coronary syndrome presenting to the Emergency Room of a large English hospital. Adjudication of myocardial infarction, as per third universal definition, involved a two-physician, blinded, independent review of all biomarker positive chest pain re-presentations to any national hospital. The primary and secondary outcome was a composite of type 1 myocardial infarction, unplanned coronary revascularisation and all cause death (MACE) at six weeks and one year. Of 3054 consecutive presentations with chest pain 1642 had suspected acute coronary syndrome (52% male, median age 59 years, 14% diabetic, 20% previous myocardial infarction). Median time from chest pain to presentation was 9.7 h. Re-presen...Continue Reading

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Citations

Oct 31, 2018·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Shannon M FernandoJeffrey J Perry
Aug 9, 2019·European Heart Journal. Acute Cardiovascular Care·Christiaan Jm Vrints
Dec 10, 2019·Annals of Internal Medicine·John A DodsonSarwat I Chaudhry
Oct 29, 2019·European Heart Journal. Acute Cardiovascular Care·Marcia CortésJuan P Costabel
Oct 15, 2021·Clinica Chimica Acta; International Journal of Clinical Chemistry·Anne Marie DupuyJean Paul Cristol

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Methods Mentioned

BETA
coronary artery bypass

Software Mentioned

Stata
GRACE

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