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Effectiveness and Safety of the European Society of Cardiology 0-/1-h Troponin Rule-Out Protocol : The Design of the ESC-TROP Multicenter Implementation Study

Mokhtari, Arash LU ; Khoshnood, Ardavan LU orcid ; Lundager Forberg, Jakob LU ; Hård Af Segerstad, Caroline ; Ekström, Ulf LU ; Schyman, Tommy ; Akbarzadeh Mameghanilar, Mahin LU ; Lindahl, Bertil and Ekelund, Ulf LU orcid (2020) In Cardiology 145(11). p.685-692
Abstract

Chest pain is one of the most common complaints at the emergency department (ED), and it is commonly the perceived likelihood of acute coronary syndrome (ACS) that drives management. Guidelines from the European Society of Cardiology (ESC) recommend the use of a 0-/1-h high-sensitivity cardiac troponin T (hs-cTnT) protocol to rule out or in ACS, but this is mostly based on observational studies. The aim of the ESC-TROP trial is to determine the safety and effectiveness of the ESC 0-/1-h hs-cTnT protocol when implemented in routine care. Adult chest pain patients at 5 EDs in the Skåne Region, Sweden, are included in the trial. The 0-/1-h hs-cTnT ESC protocol supplemented with clinical assessment and electrocardiography (ECG) is... (More)

Chest pain is one of the most common complaints at the emergency department (ED), and it is commonly the perceived likelihood of acute coronary syndrome (ACS) that drives management. Guidelines from the European Society of Cardiology (ESC) recommend the use of a 0-/1-h high-sensitivity cardiac troponin T (hs-cTnT) protocol to rule out or in ACS, but this is mostly based on observational studies. The aim of the ESC-TROP trial is to determine the safety and effectiveness of the ESC 0-/1-h hs-cTnT protocol when implemented in routine care. Adult chest pain patients at 5 EDs in the Skåne Region, Sweden, are included in the trial. The 0-/1-h hs-cTnT ESC protocol supplemented with clinical assessment and electrocardiography (ECG) is implemented at 3 EDs, and the other 2 EDs act as concurrent controls. Outcomes will be evaluated during the 10 months after the implementation and the corresponding 10 months of the previous year. The 2 co-primary outcomes are (a) acute myocardial infarction (AMI) and all-cause death within 30 days in patients discharged from the ED, and (b) ED length of stay of the same patients. Secondary outcomes include the proportion of chest pain patients discharged from the ED and the number of ruled-out patients undergoing objective testing within 30 days. The ESC-TROP trial will determine the performance and applicability of the 0-/1-h hs-cTnT ESC protocol supplemented with clinical assessment and ECG when implemented in routine ED care. It will provide evidence whether 0-/1-h hs-cTnT testing is safe, effective, and feasible, and whether widespread implementation as recommended by ESC guidelines should be supported.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiology, Troponin, Acute Coronary Syndrome, ACS, Kardiologi, Troponin, Akut Koronart Syndrom, AKS
in
Cardiology
volume
145
issue
11
pages
8 pages
publisher
Karger
external identifiers
  • scopus:85095453400
  • pmid:32818945
ISSN
1421-9751
DOI
10.1159/000509390
project
AIR Lund - Artificially Intelligent use of Registers
language
English
LU publication?
yes
id
de3370cd-6cc5-4762-bc3d-54451b3bcfe3
date added to LUP
2020-09-03 19:43:17
date last changed
2024-04-17 16:47:44
@article{de3370cd-6cc5-4762-bc3d-54451b3bcfe3,
  abstract     = {{<p>Chest pain is one of the most common complaints at the emergency department (ED), and it is commonly the perceived likelihood of acute coronary syndrome (ACS) that drives management. Guidelines from the European Society of Cardiology (ESC) recommend the use of a 0-/1-h high-sensitivity cardiac troponin T (hs-cTnT) protocol to rule out or in ACS, but this is mostly based on observational studies. The aim of the ESC-TROP trial is to determine the safety and effectiveness of the ESC 0-/1-h hs-cTnT protocol when implemented in routine care. Adult chest pain patients at 5 EDs in the Skåne Region, Sweden, are included in the trial. The 0-/1-h hs-cTnT ESC protocol supplemented with clinical assessment and electrocardiography (ECG) is implemented at 3 EDs, and the other 2 EDs act as concurrent controls. Outcomes will be evaluated during the 10 months after the implementation and the corresponding 10 months of the previous year. The 2 co-primary outcomes are (a) acute myocardial infarction (AMI) and all-cause death within 30 days in patients discharged from the ED, and (b) ED length of stay of the same patients. Secondary outcomes include the proportion of chest pain patients discharged from the ED and the number of ruled-out patients undergoing objective testing within 30 days. The ESC-TROP trial will determine the performance and applicability of the 0-/1-h hs-cTnT ESC protocol supplemented with clinical assessment and ECG when implemented in routine ED care. It will provide evidence whether 0-/1-h hs-cTnT testing is safe, effective, and feasible, and whether widespread implementation as recommended by ESC guidelines should be supported.</p>}},
  author       = {{Mokhtari, Arash and Khoshnood, Ardavan and Lundager Forberg, Jakob and Hård Af Segerstad, Caroline and Ekström, Ulf and Schyman, Tommy and Akbarzadeh Mameghanilar, Mahin and Lindahl, Bertil and Ekelund, Ulf}},
  issn         = {{1421-9751}},
  keywords     = {{Cardiology; Troponin; Acute Coronary Syndrome; ACS; Kardiologi; Troponin; Akut Koronart Syndrom; AKS}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{685--692}},
  publisher    = {{Karger}},
  series       = {{Cardiology}},
  title        = {{Effectiveness and Safety of the European Society of Cardiology 0-/1-h Troponin Rule-Out Protocol : The Design of the ESC-TROP Multicenter Implementation Study}},
  url          = {{http://dx.doi.org/10.1159/000509390}},
  doi          = {{10.1159/000509390}},
  volume       = {{145}},
  year         = {{2020}},
}