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Coronary artery disease
Original research
Single high-sensitivity troponin levels to assess patients with potential acute coronary syndromes
  1. Cara Barnes1,
  2. Daniel M Fatovich2,3,4,
  3. Stephen P J Macdonald2,3,4,
  4. Richard F Alcock1,
  5. Jon R Spiro1,3,
  6. Tom G Briffa5,
  7. Carl J Schultz1,3,
  8. Graham S Hillis1,3
  1. 1 Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
  2. 2 Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
  3. 3 Medical School, The University of Western Australia, Perth, Western Australia, Australia
  4. 4 Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
  5. 5 School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
  1. Correspondence to Professor Graham S Hillis, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia; graham.hillis{at}health.wa.gov.au

Abstract

Objective 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.

Methods 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.

Results 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.

Conclusions 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.

Trial registration number ACTRN12618000797279.

  • acute coronary syndromes
  • health care delivery
  • quality and outcomes of care

Data availability statement

De-identified patient data can be made available on reasonable request and in line with national and state legal regulations and subject to local ethical approval.

https://doi.org/10.1136/heartjnl-2020-317997

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    Data availability statement

    De-identified patient data can be made available on reasonable request and in line with national and state legal regulations and subject to local ethical approval.

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    Footnotes

    • Contributors All authors contributed to the design of the study, the interpretation of the data and to drafting, revision and approval of the manuscript. CB and GH take responsibility for the accuracy and integrity of the data.

    • Funding This work was supported by a Research Translation Project Grant from WA Health. CB was supported by a WA Health Research Registrar Fellowship.

    • Competing interests None declared.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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