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Fast prehospital rule-out using a high-sensitivity cardiac troponin T assay in a low-prevalence population for acute coronary syndrome (OUT-ACS)

Session ACVC Essentials 4 You - ePublications

Speaker Tonje R Johannessen

Event : ACVC Essentials 4 You 2020

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Coronary Syndromes: Biomarkers
  • Session type : ePublication

Authors : TR Johannessen (Oslo,NO), OM Vallersnes (Oslo,NO), AC Larstorp (Oslo,NO), I Mdala (Oslo,NO), D Atar (Oslo,NO), S Halvorsen (Oslo,NO)

Authors:
TR Johannessen1 , OM Vallersnes1 , AC Larstorp2 , I Mdala3 , D Atar4 , S Halvorsen4 , 1Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency and University of Oslo, Department of General Practice - Oslo - Norway , 2Oslo University Hospital Ulleval, Department of Medical Biochemistry and Section of Cardiovascular and Renal Research - Oslo - Norway , 3University of Oslo, Department of General Practice - Oslo - Norway , 4Oslo University Hospital Ulleval, Department of Cardiology and Institute of Clinical Medicine, University of Oslo - Oslo - Norway ,

Citation:

Background: In Norway, many patients with acute chest pain initially present to primary care emergency outpatient clinics, which serves to triage them to hospitals.

Purpose: The diagnostic utility of the 0/1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT) has been validated in large emergency department cohorts. This study aimed to validate the diagnostic and prognostic performance of the algorithm in a primary care setting, among patients not directly hospitalised, hence with a lower pre-test probability for acute coronary syndrome.

Methods: This single-centre, prospective cohort study included 1750 patients with acute non-specific chest pain from November 2016 to October 2018, at a primary care emergency outpatient clinic in Norway. Hs-cTnT was measured after 0, 1 and 4 hours, before a decision of rule-out, rule-in, or further observation was taken, according to the current European Society of Cardiology guidelines on non-ST-elevation myocardial infarction. Acute myocardial infarction (AMI) diagnoses were adjudicated by two independent cardiologists. Information on new incidents of AMIs or deaths the following 90 days were collected from all consenting patients.

Results: Among the 1711 patients remaining for analysis, median age was 56 years (IQR 45-68), 47.7% were females, and 3.6% were diagnosed with AMI. By applying the algorithm, 76.6% of the patients were assigned to rule-out, among whom 40.1% were directly ruled out by a single hs-cTnT. Patients directly ruled out were younger, 47 years (IQR 38-56), and more often female (58.6%). Only 3.9% of the patients were triaged toward rule-in, and 334 (19.5%) patients were assigned to further observation.

Conclusions: The 0/1-hour algorithm for hs-cTnT seems safe, efficient, and applicable for an accelerated assessment of patients with non-specific chest pain in a primary care emergency setting, especially for a fast rule-out of AMI. Prehospital implementation may reduce the need for hospitalization of these patients in the future, and hence decrease health care expenditure.

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