High-Sensitivity Cardiac Troponin on Presentation to Rule Out Myocardial Infarction: A Stepped-Wedge Cluster Randomized Controlled Trial

Methodology: 3.5/5
Usefulness: 3.5/5

Anand A, et al. Circulation. 2021 Jun 8;143(23):2214-2224.

Raising the Bar for Clinical Cardiac Troponin Research Studies and Implementation Science.

Question and Methods: Does implementation of an early rule-out (ERO) strategy using high-sensitivity troponin I reduce length of stay (LOS) and maintain safety outcomes at 30 days and 1 year.
Findings: LOS was reduced by 3.3 hours (95% CI, 0.73–0.83; P<0.001) and hospital admission reduced by 21% adjusted OR, 1.59 [95% CI,1.45–1.75].
Limitations: Enrolment targets not met, and standard of care required repeat troponin at 6 or 12 hours.

Interpretation: An early rule-out strategy using hs-cTn is effective at reducing ED LOS (at centres retesting 6/12 hours) for ACS and is safe to use.

By: Dr. Alex Viau

JC Supervisor: Dr. Venkatesh Thiruganasambandamoorthy

Authors

Alex Viau

Dr. Alex Viau is a FRCPC Emergency Medicine resident in the Department of Emergency Medicine, University of Ottawa.
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Hans Rosenberg

Dr. Rosenberg is an emergency physician at the Ottawa Hospital, associate professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.
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Venkatesh Thiruganasambandamoorthy

Dr. Venkatesh Thiruganasambandamoorthy is an attending physician and associate scientist at the Ottawa Hospital and Ottawa Hospital Research Institute with an particular interest in syncope and presyncope care.
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