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

doi:10.1016/j.jemrpt.2024.100086

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

Health Services Research Unit (HSRU)

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Article number	100086
Journal	JEM Reports
Early online date	14 Mar 2024
DOIs	https://doi.org/10.1016/j.jemrpt.2024.100086
Publication status	E-pub ahead of print - 14 Mar 2024

Bibliographical note

Funding
This report was prepared by the Evidence Synthesis Program Center located at the Providence VA Health Care System, directed by Eric Jutkowitz, PhD and James L. Rudolph, MD, and funded by the Department of Veterans Affairs, Health Services Research and Development.

The findings and conclusions in this document are those of the author(s) who are responsible for its contents and do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.

Acknowledgments
The authors are grateful to Gaelen Adam, MLIS for literature searching.

Keywords

Hs-cTn
Myocardial infarction
Emergency department
Accelerated diagnostic protocol

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Cite this

Hsiao, J. J., Celedon, M. A., Rudolph, J. L., Konnyu, K. J., Erqou, S. A., Baig, M., Trikalinos, T. A., Ngamdu, K. S., Kanaan, G., Cui, S., Tran, T. P., Rickard, T., Balk, E. M., & Jutkowitz, E. (2024). Accelerated diagnostic protocols using high-sensitivity troponin assays to rule in or out myocardial infarction: A systematic review. JEM Reports, Article 100086. Advance online publication. https://doi.org/10.1016/j.jemrpt.2024.100086

@article{2f8613d7e17b4c7d9d54d89be8b880e6,

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

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.",

keywords = "Hs-cTn, Myocardial infarction, Emergency department, Accelerated diagnostic protocol",

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

note = "Funding This report was prepared by the Evidence Synthesis Program Center located at the Providence VA Health Care System, directed by Eric Jutkowitz, PhD and James L. Rudolph, MD, and funded by the Department of Veterans Affairs, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents and do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report. Acknowledgments The authors are grateful to Gaelen Adam, MLIS for literature searching.",

year = "2024",

month = mar,

day = "14",

doi = "10.1016/j.jemrpt.2024.100086",

language = "English",

journal = "JEM Reports",

issn = "2773-2320",

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TY - JOUR

T1 - Accelerated diagnostic protocols using high-sensitivity troponin assays to rule in or out myocardial infarction

T2 - A systematic review

AU - Hsiao, Jonie J.

AU - Celedon, Manuel A.

AU - Rudolph, James L.

AU - Konnyu, Kristin J.

AU - Erqou, Sebhat A.

AU - Baig, Muhammad

AU - Trikalinos, Thomas A.

AU - Ngamdu, Kyari Sumayin

AU - Kanaan, Ghid

AU - Cui, Sunny

AU - Tran, Thien Phuc

AU - Rickard, Taylor

AU - Balk, Ethan M.

AU - Jutkowitz, Eric

N1 - Funding This report was prepared by the Evidence Synthesis Program Center located at the Providence VA Health Care System, directed by Eric Jutkowitz, PhD and James L. Rudolph, MD, and funded by the Department of Veterans Affairs, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents and do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report. Acknowledgments The authors are grateful to Gaelen Adam, MLIS for literature searching.

PY - 2024/3/14

Y1 - 2024/3/14

N2 - 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.

AB - 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.

KW - Hs-cTn

KW - Myocardial infarction

KW - Emergency department

KW - Accelerated diagnostic protocol

U2 - 10.1016/j.jemrpt.2024.100086

DO - 10.1016/j.jemrpt.2024.100086

M3 - Article

SN - 2773-2320

JO - JEM Reports

JF - JEM Reports

M1 - 100086

ER -

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

Abstract

Bibliographical note

Keywords

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Cite this