ACCELERATED PROTOCOL FOR MYOCARDIAL INFARCTION (MI) RULE-OUT WITHIN 1-HOUR OF PRESENTATION REDUCES HEALTHCARE RESOURCE UTILIZATION - SECONDARY ANALYSIS OF RACE-IT TRIAL

Document Type

Conference Proceeding

Publication Date

3-7-2023

Publication Title

J Am Coll Cardiol

Abstract

Background: We compared healthcare resource utilization between a 3-hour standard care protocol for exclusion of myocardial infarction (MI) in the Emergency Department (ED) to a more rapid 0/1-hour high-sensitivity cardiac troponin (hs-cTnI) accelerated protocol.

Methods: This was a secondary analysis of the RACE-IT trial, a stepped-wedge randomized trial performed across 9 EDs in the Henry Ford Health System (Detroit, MI) from 7/2020-3/2021. A hs-cTnI assay was used (Beckman Coulter, 99th percentile 18 ng/L). In the accelerated protocol, MI was excluded if hs-cTnI was < 4 ng/L at presentation, or = 4 ng/L at presentation with a 1-hour value < 8 ng/L. In the standard care protocol, MI was excluded if hs-cTnI values were ≤18 ng/L at 0 and 3 hours. Outcomes included ED discharge, cardiac stress testing, cardiology consultation, and cardiac revascularization within 30 days. Generalized linear mixed models were used to compare the two arms.

Results: A total of 23,949 patients were analyzed, including 10,444 in the accelerated protocol and 13,505 in the standard care arm. Patients in the accelerated arm had higher odds of ED discharge, and lower odds of stress testing and cardiology consultation (table). There was no difference in odds of coronary angiograms or revascularization procedures.

Conclusion: Patients that had MI excluded by the 0/1-hour protocol had higher odds of ED discharge, and lower odds of stress testing and cardiology consultation when compared to the standard care 3-hour protocol.

Volume

81

Issue

8

First Page

1125

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