Rapid Acute Coronary Syndrome Evaluation Over One Hour With High-Sensitivity Cardiac Troponin I: A United States-Based Stepped-Wedge, Randomized Trial
Recommended Citation
Miller J, Cook B, Gandolfo C, Mills NL, Mahler S, Levy P, Parikh S, Krupp S, Nour K, Klausner H, Gindi R, Lewandowski A, Hudson M, Perrotta G, Zweig B, Lanfear D, Kim H, Dangoulian S, Tang A, Todter E, Khan A, Keerie C, Bole S, Nasseredine H, Oudeif A, Abou Asala E, Mohammed M, Kazem A, Malette K, Singh-Kucukarslan G, Xu N, Wittenberg S, Morton T, Gunaga S, Affas Z, Tabbaa K, Desai P, Alsaadi A, Mahmood S, Schock A, Konowitz N, Fuchs J, Joyce K, Shamoun L, Babel J, Broome A, Digiacinto G, Shaheen E, Darnell G, Muller G, Heath G, Bills G, Vieder J, Rockoff S, Kim B, Colucci A, Plemmons E, and McCord J. Rapid Acute Coronary Syndrome Evaluation Over One Hour With High-Sensitivity Cardiac Troponin I: A United States-Based Stepped-Wedge, Randomized Trial. Ann Emerg Med 2024.
Document Type
Article
Publication Date
10-1-2024
Publication Title
Annals of emergency medicine
Keywords
Humans, Male, Female, Troponin I, Middle Aged, Acute Coronary Syndrome, Emergency Service, Hospital, United States, Aged, Myocardial Infarction, Biomarkers, Time Factors
Abstract
STUDY OBJECTIVE: The real-world effectiveness and safety of a 0/1-hour accelerated protocol using high-sensitivity cardiac troponin (hs-cTn) to exclude myocardial infarction (MI) compared to routine care in the United States is uncertain. The objective was to compare a 0/1-hour accelerated protocol for evaluation of MI to a 0/3-hour standard care protocol.
METHODS: The RACE-IT trial was a stepped-wedge, randomized trial across 9 emergency departments (EDs) that enrolled 32,609 patients evaluated for possible MI from July 2020 through April 2021. Patients undergoing high-sensitivity cardiac troponin I testing with concentrations less than or equal to 99th percentile were included. Patients who had MI excluded by the 0/1-hour protocol could be discharged from the ED. Patients in the standard care protocol had 0- and 3-hour troponin testing and application of a modified HEART score to be eligible for discharge. The primary endpoint was the proportion of patients discharged from the ED without 30-day death or MI.
RESULTS: There were 13,505 and 19,104 patients evaluated in the standard care and accelerated protocol groups, respectively, of whom 19,152 (58.7%) were discharged directly from the ED. There was no significant difference in safe discharges between standard care and the accelerated protocol (59.5% vs 57.8%; adjusted odds ratio (aOR)=1.05, 95% confidence interval [CI] 0.95 to 1.16). At 30 days, there were 90 deaths or MIs with 38 (0.4%) in the standard care group and 52 (0.4%) in the accelerated protocol group (aOR=0.84, 95% CI 0.43 to 1.68).
CONCLUSION: A 0/1-hour accelerated protocol using high-sensitivity cardiac troponin I did not lead to more safe ED discharges compared with standard care.
Medical Subject Headings
Humans; Male; Female; Troponin I; Middle Aged; Acute Coronary Syndrome; Emergency Service, Hospital; United States; Aged; Myocardial Infarction; Biomarkers; Time Factors
PubMed ID
38888531
Volume
84
Issue
4
First Page
399
Last Page
408
