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Effects of implementation of the ESC 0/1-hour algorithm on efficiacy and safety of discharge after rule-out in a consecutive cohort of patients with suspected acute coronary syndrome - RAPID-CPU study

Session Cardiac troponins and other biomarkers in acute coronary syndromes

Speaker Kiril M Stoyanov

Event : ESC Congress 2019

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

Authors : K M Stoyanov (Heidelberg,DE), H Hund (Heidelberg,DE), M Biener (Heidelberg,DE), J Gandowitz (Heidelberg,DE), C Riedle (Heidelberg,DE), J Loehr (Heidelberg,DE), M Mueller-Hennessen (Heidelberg,DE), M Vafaie (Heidelberg,DE), H A Katus (Heidelberg,DE), E Giannitsis (Heidelberg,DE)

Authors:
K M Stoyanov1 , H Hund1 , M Biener1 , J Gandowitz1 , C Riedle1 , J Loehr1 , M Mueller-Hennessen1 , M Vafaie1 , H A Katus1 , E Giannitsis1 , 1University Hospital of Heidelberg, Department of Cardiology, Angiology and Pneumology - Heidelberg - Germany ,

Citation:

Aims: The feasibility, efficacy and safety of ESC 0/1- and 0/3-hour algorithms using high-sensitivity troponin T (hsTnT) were evaluated in an all-comer cohort with suspected acute coronary syndrome, based on a broad spectrum of symptoms.
Methods: During 12 months, 2,525 eligible patients were enrolled. In a pre-implementation period of 6 months, prevalence of protocols, disposition, lengths of emergency department (ED) stay and treatments were registered. Implementation of ESC 0/1-hour protocol was monitored for another 6 months. Primary endpoints comprised the change of diagnostic protocols, and all-cause mortality at 30 days following direct discharge from the ED. Secondary endpoints included length of ED stay, hospital discharge, and 1-year mortality.
Results: Use of the ESC 0/1-hour algorithm increased by 270% at the cost of the standard 0/3-hour protocol. Median follow-up times were 400 (316-459) days, with vital status available for 98.7%. After rule-out (1,588 patients), 1,309 patients (76.1%) were discharged directly from the ED, with an all-cause mortality of 0.08% at 30 days (1 death due to lung cancer). Median lengths of stay were 2.9 (1.9-3.8) and 3.2 (2.7-4.4) hours using a single hsTnT below limit of detection (LoD) (5 ng/L) at presentation and the ESC 0/1-hour algorithm, respectively, as compared to 5.3 (4.7-6.5) hours using the ESC 0/3-hour rule-out protocol. Discharge rates increased from 53.9% to 62.8% (p<0.0001), without excessive use of diagnostic resources within 30 days.
Conclusion: Implementation of the ESC 0/1-hour algorithm seems feasible and safe. It is associated with shorter ED stays than the ESC 0/3-hour protocol and a further increase of discharge rates.

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