Accelerated diagnostic protocols using high-sensitivity troponin assays to rule in or out myocardial infarction: A systematic review
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
Affiliations
Jonie J. Hsiao
Department of Emergency Medicine, Greater Los Angeles Veteran's Affairs Hospital, Los Angeles, CA, USA; Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Manuel A. Celedon
Department of Emergency Medicine, Greater Los Angeles Veteran's Affairs Hospital, Los Angeles, CA, USA; Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
James L. Rudolph
Evidence Synthesis Program Center Providence VA Medical Center, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, RI, USA
Kristin J. Konnyu
Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
Sebhat A. Erqou
Evidence Synthesis Program Center Providence VA Medical Center, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, RI, USA
Muhammad Baig
Evidence Synthesis Program Center Providence VA Medical Center, Providence, RI, USA
Thomas A. Trikalinos
Evidence Synthesis Program Center Providence VA Medical Center, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
Kyari Sumayin Ngamdu
Evidence Synthesis Program Center Providence VA Medical Center, Providence, RI, USA
Ghid Kanaan
Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
Sunny Cui
Evidence Synthesis Program Center Providence VA Medical Center, Providence, RI, USA
Thien Phuc Tran
Evidence Synthesis Program Center Providence VA Medical Center, Providence, RI, USA
Taylor Rickard
Evidence Synthesis Program Center Providence VA Medical Center, Providence, RI, USA
Ethan M. Balk
Evidence Synthesis Program Center Providence VA Medical Center, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
Eric Jutkowitz
Evidence Synthesis Program Center Providence VA Medical Center, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA; Corresponding author. Evidence Synthesis Program Center Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI, 02908, USA.
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.
