Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia.
Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.
Heart. 2021 May;107(9):721-727. doi: 10.1136/heartjnl-2020-317997. Epub 2021 Jan 12.
We tested the hypothesis that patients with a potential acute coronary syndrome (ACS) and very low levels of high-sensitivity cardiac troponin I can be efficiently and safely discharged from the emergency department after a single troponin measurement.
This prospective cohort study recruited 2255 consecutive patients aged ≥18 years presenting to the Emergency Department, Royal Perth Hospital, Western Australia, with chest pain without high-risk features but requiring the exclusion of ACS. Patients were managed using a guideline-recommended pathway or our novel Single Troponin Accelerated Triage (STAT) pathway. The primary outcome was the percentage of patients discharged in <3 hours. Secondary outcomes included the duration of observation and death or acute myocardial infarction in the next 30 days.
The study enrolled 1131 patients to the standard cohort and 1124 to the STAT cohort. Thirty-eight per cent of the standard cohort were discharged directly from emergency department compared with 63% of the STAT cohort (p<0.001). The median duration of observation was 4.3 (IQR 3.3-7.1) hours in the standard cohort and 3.6 (2.6-5.4) hours in the STAT cohort (p<0.001), with 21% and 38% discharged in <3 hours, respectively (p<0.001). No patients discharged directly from the emergency department died or suffered an acute myocardial infarction within 30 days in either cohort.
Among low-risk patients with a potential ACS, a pathway which incorporates early discharge based on a single very low level of high-sensitivity cardiac troponin increases the proportion of patients discharged directly from the emergency department, reduces length of stay and is safe.
ACTRN12618000797279.
我们验证了这样一个假设，即对于存在潜在急性冠状动脉综合征（ACS）且高敏肌钙蛋白 I 水平极低的患者，单次肌钙蛋白测量后，可安全有效地从急诊科出院。
这项前瞻性队列研究纳入了 2255 例连续就诊于西澳大利亚州珀斯皇家医院急诊科、胸痛但无高危特征、需要排除 ACS 的≥18 岁患者。患者采用指南推荐的流程或我们的新型单次肌钙蛋白加速分诊（STAT）流程进行管理。主要结局是 3 小时内出院的患者比例。次要结局包括观察时间以及 30 天内死亡或急性心肌梗死的发生率。
本研究纳入标准队列 1131 例患者，纳入 STAT 队列 1124 例患者。标准队列中 38%的患者直接从急诊科出院，而 STAT 队列中 63%的患者直接从急诊科出院（p<0.001）。标准队列的中位观察时间为 4.3（IQR 3.3-7.1）小时，STAT 队列为 3.6（2.6-5.4）小时（p<0.001），分别有 21%和 38%的患者在 3 小时内出院（p<0.001）。两个队列中均无直接从急诊科出院的患者在 30 天内死亡或发生急性心肌梗死。
对于存在潜在 ACS 的低危患者，基于单次非常低水平的高敏肌钙蛋白实施早期出院的流程可增加直接从急诊科出院的患者比例，缩短住院时间，且安全。
ACTRN12618000797279。
