Measurement of high-sensitivity troponin-I in suspected coronary-related chest pain in Emergency Departments.

Abstract

The study aimed to evaluate a new algorithm based on analyses of high-sensitivity troponin I for rapid diagnostic clarification in cases of suspected cardiac chest pain. Two time periods - before (01.10.2016-31.12.2016) and after (01.03.2017-28.02.2018) the introduction of a diagnostic algorithm - were studied by reviewing the medical records of patients who arrived at the emergency department with chest pain. The diagnostic algorithm included a high-sensitivity troponin I test on admission (0hours) and one hour later (the 0h/1h algorithm). The primary endpoint was the proportion of patients that were discharged directly from the emergency department. Secondary endpoints were acute cardiac arrest and death within 30 days and within one year. A larger proportion of patients with chest pain were discharged directly from the emergency department when the 0h/1h algorithm was used (10/91 (11%) before versus 118/306 (39%) after, p <0.001). Deaths and the incidence of acute myocardial infarction one year after the introduction of the 0h/1h algorithm were low (≤3%) and not statistically different from the period before the introduction (p≥0.20). The implementation of a diagnostic algorithm based on measurements of high-sensitivity troponin I resulted in fewer patients being hospitalised, and we did not register more deaths or deaths from myocardial infarction. The algorithm was suitable for identifying patients with chest pain who could safely be discharged without the need for hospitalisation, which we believe may optimise patient flow in hospitals.