Point-of-care high-sensitivity troponin I shortens ED stays for possible acute coronary syndrome
This stepped-wedge cluster randomized trial evaluated point-of-care high-sensitivity troponin I (POC hs-cTnI) testing within an accelerated diagnostic pathway for possible acute coronary syndrome. Conducted across six emergency departments, the study included 44,747 individuals (mean age 61±19 years, 49.5% female) and 59,980 ED presentations. The comparator was usual care using a single-sample rule-out step with central laboratory hs-cTn assay. The primary outcome was ED length of stay; secondary outcomes included 30-day MI or cardiac death over 30 days of follow-up.
ED length of stay was reduced by 13% (47 minutes; 95% CI, 9 to 16%; 47 minutes, 95% CI, 33 to 61 minutes; P<0.001) with POC hs-cTnI. The mean length of stay in the control arm was 376 minutes. Thirty-day MI or cardiac death was 0.39% in both control and intervention arms (P=0.54), indicating no difference in safety outcomes.
Adverse events, serious adverse events, discontinuations, and overall tolerability were not reported. The authors concluded that implementing whole-blood POC hs-cTnI testing in an accelerated pathway was safe and reduced ED length of stay compared with laboratory testing.
Key limitations include the stepped-wedge design, which may allow for contamination across sites, and the absence of detailed safety data. Generalizability may be affected by local workflows and assay performance. Clinicians should consider these results as supportive of implementation while confirming that local processes and patient populations align with the study setting.
View Original Abstract ↓
Evolocumab reduces cardiovascular events in diabetes without known atherosclerosis
Evolocumab cuts heart events in high-risk diabetes patients
Related in Cardiology
From Other Specialties
