scholarly journals Implementation of the ESC 0/3hour accelerated diagnostic protocol,utilising high sensitive troponin T, for suspected acute coronary syndrome:a study on clinical effectiveness involving 3016 patients

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
S Mohmed ◽  
M Campbell ◽  
K Batouskaya ◽  
M Obeidat ◽  
A Khand
Keyword(s):  
Length Of Stay ◽  
Acute Coronary Syndromes ◽  
Limit Of Detection ◽  
Troponin T ◽  
Discharge Rate ◽  
Clinical Effectiveness ◽  
Coronary Syndromes ◽  
High Sensitive Troponin ◽  
Rule Out

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Liverpool University Hospitals NHS Foundation Trust Background There have been relatively few studies detailing the real-world effectiveness and safety of accelerated diagnostic protocols (ADP), using high sensitivity troponins (HSTN). Purpose  To analyse the safety and effectiveness of early emergency room (ER) discharge following implementation of the ESC 0/3-hour ADP for suspected acute coronary syndromes (ACS) Method We prospectively studied 2 cohorts of consecutive suspected acute coronary syndromes (ACS) presentations to ER before (n = 1642) and after (n = 1376, 2 centres) implementation of the ESC 0/3-hour ADP incorporating limit of detection rule out. All index presentations with HSTNT (high sensitive troponin T) >99th percentile underwent independent two physician adjudication for MI (myocardial infarction) using all available data to six weeks.  Safety was defined by both NPV (negative predictive value) and sensitivity for type 1 or type 2 MI for those with ER discharge and clinical effectiveness by percentage ER discharge. Results In the pre-implementation period there was a higher prevalence of MI. Discharge from ER increased by >100% to 56% of the cohort, when the ADP was implemented. This correlated with a marked reduction in length of stay overall and a more modest reduction for those discharged from ER (table) The greatly increased ER discharge was safe with no signal for hazard. Analysis of HSTNT values and ECGS revealed a maximum ER discharge rate of 69%, by applying the 0/3-hour protocol, implying potential for further increasing safe ER discharge. Conclusions Implementation of an ADP with HSTNs is safe and effective for early rule-out and discharge of suspected ACS. Further research into the shortfall between theoretical and actual early ER discharge achieved is warranted. DischargePre-implementation0/3hour ADP implementationP valuen16421376% male52.352.1nsAge (median)5855<0.001Index Type 1 or 2 MI prevalence (%)11.96<0.001% discharged from ER2756<0.001Median total length of stay (hours) {global population}16.37.1<0.001Median length of stay (hours)- discharged from ER6.25.4<0.001NPV for index type 1 or 2 MI (discharged from ER)99.399.7nsSensitivity index type 1 or 2 MI (discharged from ER)98.597.6ns

Modified HEART score, utilising a single high-sensitive troponin sample, allows early, safe discharge of suspected acute coronary syndrome: a prospective multicentre cohort study of 3016 patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Khand ◽  
M Obeidat ◽  
M Campbell ◽  
K Batouskaya ◽  
L Mullen ◽  
...  
Keyword(s):  
Limit Of Detection ◽  
Troponin T ◽  
Public Institution ◽  
Risk Scores ◽  
Funding Source ◽  
Catchment Population ◽  
Heart Score ◽  
Coronary Syndrome ◽  
High Sensitive Troponin

Abstract Background Combining HSTnT (high sensitive troponin T) values at low levels with composite risk scores may improve early safe, discharge in suspected acute coronary syndromes (ACS). We tested this hypothesis by a prospective study of 3016 consecutive patients with suspected ACS in 2 large hospitals. Methods Consecutive chest pain (CP) presentations with HSTnT sampled and ECG undertaken at presentation were prospectively defined in 2 time periods (2011-12, n=1642 [derivation] 2018, n=1376 [validation]). The HstnT input was modified: dichotomous HSTnT input was lowered to <5 (limit of detection, LOD) or ≥5ng/l (mod TIMI and GRACE), HEART score was re-calibrated (<5 = 0 [LOD], ≥5–14 = 1, >14 = 2 [99th percentile]). All biomarker positive CP index and re-admissions to any regional hospital (catchment population 2.6 million) were independently adjudicated for MI by 2 experienced physicians. Primary outcome was MACE (adjudicated type 1 MI, unplanned coronary revascularisation and all cause death) at 6 weeks. Results In the 2 cohorts demographic factors were similar: median age 59 and 56, male 52% and 52%, previous MI 20% and 14% for 2011-12 and 2018 respectively. At 6 weeks 180 (11%) and 75 (5.4%) suffered type 1 MI and 211 (12.9%) and 92 (6.7%) patients suffered MACE in the 2011-12 and 2018 cohorts respectively. Only Mod HEART ≤3 and undetectable HSTnT, with a nonischaemic ECG, achieved prespecified NPV of >99.5% in both derivation and validation cohorts (table). However Modified HEART ≤3 score could discharge approximately 12% more patients as compared to undetectable HSTnT strategy. Conclusion Modified HEART score ≤3, with the use of a single HSTnT, appears the optimum early discharge strategy for suspected ACS Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Liverpool university Hospitals, North-West Educational Cardiac Group

scholarly journals PRe-hospital Evaluation of Sensitive TrOponin (PRESTO) Study: multicentre prospective diagnostic accuracy study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e032834 ◽  
Author(s):  
Abdulrhman Alghamdi ◽  
Eloïse Cook ◽  
Edward Carlton ◽  
Aloysius Siriwardena ◽  
Mark Hann ◽  
...  
Keyword(s):  
Chest Pain ◽  
Hospital Admission ◽  
Diagnostic Accuracy ◽  
Blood Sample ◽  
Acute Coronary Syndromes ◽  
Venous Blood ◽  
Prehospital Setting ◽  
Registration Number ◽  
Coronary Syndromes ◽  
Rule Out

IntroductionWithin the UK, chest pain is one of the most common reasons for emergency (999) ambulance calls and the most common reason for emergency hospital admission. Diagnosing acute coronary syndromes (ACS) in a patient with chest pain in the prehospital setting by a paramedic is challenging. The Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision rule is a validated tool used in the emergency department (ED) to stratify patients with suspected ACS following a single blood test.We are seeking to evaluate the diagnostic accuracy of the T-MACS decision aid algorithm to ‘rule out’ ACS when used in the prehospital environment with point-of-care troponin assays. If successful, this could allow paramedics to immediately rule out ACS for patients in the ‘very low risk’ group and avoid the need for transport to the ED, while also risk stratifying other patients using a single blood sample taken in the prehospital setting.Methods and analysisWe will recruit patients who call emergency (999) ambulance services where the responding paramedic suspects cardiac chest pain. The data required to apply T-MACS will be prospectively recorded by paramedics who are responding to each patient. Paramedics will be required to draw a venous blood sample at the time of arrival to the patient. Blood samples will later be tested in batches for cardiac troponin, using commercially available troponin assays. The primary outcome will be a diagnosis of acute myocardial infarction, established at the time of initial hospital admission. The secondary outcomes will include any major adverse cardiac events within 30 days of enrolment.Ethics and disseminationThe study obtained approval from the National Research Ethics Service (reference: 18/ES/0101) and the Health Research Authority. We will publish our findings in a high impact general medical journal.Trial registration numberRegistration number: ClinicalTrials.gov, study ID: NCT03561051

scholarly journals Early Discharge in Low-Risk Patients Hospitalized for Acute Coronary Syndromes: Feasibility, Safety and Reasons for Prolonged Length of Stay

PLoS ONE ◽  
2016 ◽  
Vol 11 (8) ◽  
pp. e0161493 ◽  
Author(s):  
Marie-Eva Laurencet ◽  
François Girardin ◽  
Fabio Rigamonti ◽  
Anne Bevand ◽  
Philippe Meyer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Coronary Syndromes ◽  
Early Discharge ◽  
Low Risk ◽  
Prolonged Length ◽  
Risk Patients ◽  
Coronary Syndromes

Validation of a prediction score model to distinguish acute coronary syndromes from other conditions causing raised cardiac troponin T levels

2010 ◽  
Vol 21 (6) ◽  
pp. 363-368 ◽  
Author(s):  
Peter S.C. Wong ◽  
Gopala K. Rao ◽  
Antony L. Innasimuthu ◽  
Yawer Saeed ◽  
Charles van Heyningen ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Acute Coronary Syndromes ◽  
Troponin T ◽  
Prediction Score ◽  
Cardiac Troponin T ◽  
Coronary Syndromes ◽  
Score Model

Impact of European Society of Cardiology/American College of Cardiology guidelines on diagnostic classification of patients with suspected acute coronary syndromes

2003 ◽  
Vol 40 (2) ◽  
pp. 156-160 ◽  
Author(s):  
P. O. Collinson ◽  
A. C. Rao ◽  
R. Canepa-Anson ◽  
S. Joseph
Keyword(s):  
Acute Coronary Syndromes ◽  
Troponin T ◽  
Myocardial Damage ◽  
District General Hospital ◽  
Relative Increase ◽  
World Health ◽  
Absolute Increase ◽  
Who Criteria ◽  
Diagnostic Strategies ◽  
Coronary Syndromes

Background: Assessment of the relative diagnostic accuracy of investigation strategies for patients with suspected acute coronary syndromes (ACS). Methods: A prospective observational study followed two groups of patients over a 3-month period in a UK district general hospital. Group one: all admissions with suspected ACS ( n = 576); group two: non-cardiac in-patients who were suspected of developing ACS ( n = 87). Both were investigated by full clinical history, examination and serial electrocardiographs (ECGs). Conventional World Health Organization (WHO) criteria for myocardial damage were compared with diagnosis based on cardiac troponin T (cTnT). Clinical discharge diagnosis based on conventional WHO criteria was compared with the review diagnosis based on measurement of cTnT. Results: Diagnosis based on WHO criteria missed 58 patients (8·7%) admitted with suspected ACS who had high risk unstable angina. Thirty-three patients (5% of all admissions) who were diagnosed as non-Q wave acute myocardial infarction (AMI) were found to have normal troponin values and to have been incorrectly classified as AMI. Conclusions: Diagnostic strategies based on WHO criteria are inaccurate. The measurement of cTnT in all patients with suspected ACS would have increased the number of those with a diagnosis of AMI by 58 (8·7%), while avoiding inaccurate diagnosis in 33 (5%), therefore producing an absolute increase of 25/663 (3·8%) but a relative increase of 58/138 (42%). In patients with a primary diagnosis of suspected ACS, the overall increase in patients with a diagnosis of AMI will be 55 (9·5%), a relative increase of 55/118 (46·6%) but an absolute increase of 36/576 (6·3%).

scholarly journals The inter-relationship between creatinine clearance, cardiac troponin T and outcomes in patients with acute coronary syndromes

2002 ◽  
Vol 39 ◽  
pp. 305
Author(s):  
Ronnier J. Aviles ◽  
Arman T. Askari ◽  
E.Magnus Ohman ◽  
Kenneth W. Mahaffy ◽  
L.Kristin Newby ◽  
...  
Keyword(s):  
Creatinine Clearance ◽  
Cardiac Troponin ◽  
Acute Coronary Syndromes ◽  
Troponin T ◽  
Cardiac Troponin T ◽  
Coronary Syndromes
Sign in / Sign up

Export Citation Format

Share Document