Accelerated diagnostic protocols using high-sensitivity troponin assays to rule in or out myocardial infarction: A systematic review

JEM reports Pub Date : 2024-03-14 DOI:10.1016/j.jemrpt.2024.100086

Jonie J. Hsiao , Manuel A. Celedon , James L. Rudolph , Kristin J. Konnyu , Sebhat A. Erqou , Muhammad Baig , Thomas A. Trikalinos , Kyari Sumayin Ngamdu , Ghid Kanaan , Sunny Cui , Thien Phuc Tran , Taylor Rickard , Ethan M. Balk , Eric Jutkowitz

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Abstract

Background

Accelerated diagnostic protocols (ADPs) that incorporate high-sensitivity cardiac troponin (hs-cTn) can help emergency department (ED) providers quickly rule in or out acute myocardial infarction (AMI).

Objectives

This systematic review evaluated the effectiveness and comparative effectiveness of clinically applied ADPs that use hs-cTn on clinical and health service use outcomes.

Methods

Medline, Embase, ClinicalTrials.gov, and the Cochrane Database of Systematic Reviews were searched through May 2022. Standard systematic review methods were followed.

Results

We found 17 eligible primary studies (reporting on 23 ADPs), including 2 randomized controlled trials (N = 32,050), 5 nonrandomized comparative studies (N = 18,377) and 10 single-group studies (N = 44,016). One study compared an ADP with hs-cTn to hs-cTn alone, finding that the ADP increased discharges from the ED to the community and is not associated with worse clinical outcomes. Among 6 studies, ADPs with shorter compared to longer hs-cTn timing and ADPs that incorporated the HEART score compared to the TIMI score reduced ED length of stay and increased discharges to the community without resulting in worse clinical outcomes. Across studies, ADPs that measured hs-cTn for up to 12 h had longer ED lengths of stay than ADPs with ≤6 h of measurements.

Conclusions

ADPs with shorter compared to longer hs-cTn timing reduce ED length of stay, increase discharges, and are not associated with changes in 30-day major adverse cardiovascular event, AMI, or mortality. Among ADPs that reduce ED length of stay, there is no obvious best choice, and any ADP should be tailored to local context.

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使用高敏肌钙蛋白检测加速诊断方案，以排除心肌梗死：系统综述

背景采用高敏心肌肌钙蛋白（hs-cTn）的快速诊断方案（ADP）可帮助急诊科（ED）服务提供者快速排除急性心肌梗死（AMI）.目的本系统综述评估了临床应用中使用 hs-cTn 的 ADP 在临床和医疗服务使用结果方面的有效性和比较有效性.方法检索了截至 2022 年 5 月的 Medline、Embase、ClinicalTrials.gov 和 Cochrane 系统综述数据库.结果我们发现了 17 项符合条件的主要研究（报告了 23 项 ADP），包括 2 项随机对照试验（N = 32,050 ）和 5 项非随机比较研究（N = 32,050 ）.我们采用了标准的系统综述方法.结果我们发现了17项符合条件的主要研究（报告了23项ADP），包括2项随机对照试验（N = 32,050）、5项非随机对照研究（N = 18,377）和10项单组研究（N = 44,016）。一项研究将 ADP 与 hs-cTn 进行了比较，结果发现 ADP 增加了从急诊室到社区的出院率，但与更差的临床结果无关。在 6 项研究中，hs-cTn 时间较短的 ADP 与时间较长的 ADP 相比，采用 HEART 评分的 ADP 与采用 TIMI 评分的 ADP 相比，缩短了急诊室的住院时间，增加了出院到社区的人数，但不会导致更差的临床预后。结论与测量 hs-cTn 时间较长的 ADP 相比，测量 hs-cTn 时间较短的 ADP 缩短了急诊室住院时间，增加了出院率，但与 30 天主要不良心血管事件、急性心肌梗死或死亡率的变化无关。在缩短急诊室住院时间的 ADP 中，没有明显的最佳选择，任何 ADP 都应根据当地情况量身定制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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