GW25-e5175 Point-of-care sensitive cardiac troponin I in the rapid triage of chest pain patients in emergency department

  • Zi Y
  • Ying-Xiong H
  • Zi-Yu Z
  • et al.
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Abstract

Objectives: To evaluate the clinical effectiveness of point-of-care sensitive cardiac troponin I (POC-cTnI) in emergency department setting amongst acute chest pain patients with suspected NSTEMI. Methods: 220 participants who suspected with NSTEMI were recruited consecutively between July 2012 and January 2013, the participants were randomized into two groups (POCT vs CLT) after having their baseline characteristics collected. In the POCT arm, patients had their POCT levels measured both at time zero of emergency attendance and 3 hours after emergency admission. In the CLT arm, patients were managed with current hospital guidelines, including a CLT-cTnT level both upon attendance and 6 hours after, while the other diagnostic and/or therapeutic managements were at the discretion of the clinician. All participants were followed for 90 days. The primary outcome measures: 1 the triage decision-making time and the duration of initial emergency stay; 2. the rate of successful home discharges within 6 hours after Emergency visit and no MACE up to 90 days. The secondary outcome measures included the duration of cardiology department/CCU stay, the subsequent outpatient's visits, emergency revisits, hospital readmissions and major adverse cardiac events over the 90 days follow-up. Results: 216 participants were successfully followed up. 1 and 3 patients lost to follow-up in POCT arm and CTL arm respectively. The POCT arm was associated with less time on mean time of triage decision-making (246min vs 178.5min; P<0.001), reduced mean length of initial emergency stay (7.2h vs 10.1h; P<0.001), and increased rate of successful discharge at initial attendances (37/109 (33.9%) vs 9/107 (8.4%) ; OR 7.153,95%CI 3.051 to 16.774; P<0.001). Between the two arms, there was no difference in the mean duration of cardiovascular wards stay (including cardiology department and CCU) (3.1 vs 3.0; P=0.972). Nevertheless, the POCT arm has more mean inpatients days in CCU (2.0 vs 0.8,P =0.045) and less mean inpatients days in cardiology department (1.1 vs 2.3,P=0.038). At 90 days follow-up, the POCT arms had a lower rate of emergency department re-attendance (11 (10.6%) vs 22 (21.2%) ; P=0.037) and also a lower rate of hospitalization for cardio-vascular reasons (12 (11.0%) vs 24 (22.4%) ; OR 0.42,95%CI 0.200 to 0.920; P=0.030). Meanwhile, there is no difference in any adverse event of MACE, including death, non-fatal myocardial infarction, or hospitalization for cardio-vascular reasons without myocardial infarction (44 (40.4%) vs 47 (43.9%); OR 0.850, 95%CI 0.485 to 1.490; P=0.571). Conclusions: POC-cTnI assessment could rapidly triage chest pain patients with suspected AMI. This assay could especially increase the rate of successful discharge amongst low-risk patients, while not increasing the occurrence of MACE at 90 days follow-up

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Zi, Y., Ying-Xiong, H., Zi-Yu, Z., Hong, Z., Jia, X., Peng, J., … Xin, L. (2014). GW25-e5175 Point-of-care sensitive cardiac troponin I in the rapid triage of chest pain patients in emergency department. Journal of the American College of Cardiology, 64(16), C131. https://doi.org/10.1016/j.jacc.2014.06.605

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