Department of Cardiology Lund University, Skåne University Hospital Lund Sweden.
Department of Emergency Medicine Helsingborg Hospital Helsingborg Sweden.
J Am Heart Assoc. 2024 Nov 5;13(21):e036307. doi: 10.1161/JAHA.124.036307. Epub 2024 Oct 29.
European guidelines recommend the use of a 0h/1h hs-cTn (high-sensitivity cardiac troponin) protocol in patients with acute chest pain. We aimed to determine the performance of this protocol in routine care when supplemented with patient history and ECG and a recommendation to refrain from noninvasive testing in low-risk patients.
This was a pre- and postimplementation study with concurrent controls. Patients with chest pain were enrolled at 5 Swedish emergency departments (EDs) during a 10-month period in both 2017 and 2018. All hospitals used a 0h/3h hs-cTnT protocol in 2017 and 3 EDs implemented a 0h/1h hs-cTnT protocol during 10 months in 2018. The 2 coprimary outcomes were the incidence of acute myocardial infarction and all-cause death within 30 days and ED length of stay. The study included 26 040 consecutive patients. In the intervention hospitals, 21 (0.40%) of the discharged patients had an acute myocardial infarction/death event during the control period (0h/3h testing) and 22 (0.45%) in the intervention period (0h/1h testing), which met the criteria for noninferiority. There was no significant difference in ED length of stay (ratio 0.99, =0.48) or ED discharge rate between the periods in the intervention versus the control hospitals. A total of 3142 patients met low-risk 0h/1h hs-cTnT criteria and were discharged, of whom 2 had an acute myocardial infarction/death event.
A 0h/1h hs-cTnT protocol incorporating patient history and ECG was as safe as using a 0h/3h protocol but did not reduce ED length of stay or increase the discharge rate. Refraining from noninvasive testing in patients identified as low risk was safe.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03421873.
欧洲指南建议在急性胸痛患者中使用 0h/1h hs-cTn（高敏心肌肌钙蛋白）方案。我们旨在确定当该方案结合病史和心电图，并建议低危患者避免进行无创检查时，在常规护理中的表现。
这是一项在 2017 年和 2018 年期间，在瑞典的 5 家急诊部门（EDs）进行的前瞻性和实施后对照研究。所有医院在 2017 年都使用了 0h/3h hs-cTnT 方案，在 2018 年的 10 个月中，有 3 家 ED 实施了 0h/1h hs-cTnT 方案。主要转归指标为 30 天内急性心肌梗死和全因死亡的发生率以及 ED 住院时间。该研究纳入了 26040 例连续患者。在干预医院，在对照组（0h/3h 检测）期间出院的 21 例（0.40%）患者和干预组（0h/1h 检测）期间出院的 22 例（0.45%）患者发生急性心肌梗死/死亡事件，符合非劣效性标准。在干预与对照组 ED 住院时间（比值 0.99，=0.48）或 ED 出院率方面无显著差异。共有 3142 例患者符合低危 0h/1h hs-cTnT 标准并出院，其中 2 例发生急性心肌梗死/死亡事件。
结合病史和心电图的 0h/1h hs-cTnT 方案与使用 0h/3h 方案一样安全，但并未降低 ED 住院时间或增加出院率。对于被确定为低危的患者，避免进行无创检查是安全的。
