Effectiveness of Point-of-Care High-Sensitivity Troponin Testing in the Emergency Department: A Randomized Controlled Trial

医学 急诊科 随机对照试验 检测点注意事项 急诊医学 注意事项 肌钙蛋白 灵敏度(控制系统) 医疗急救 肌钙蛋白I 内科学 护理部 心肌梗塞 电子工程 工程类 免疫学
作者
Viola I L Thulin,Silje Marie Farestveit Jordalen,Gard M. S. Myrmel,Ole Christian Lekven,Jeyaseelan Krishnapillai,Ole Thomas Steiro,Richard Body,Paul Collinson,Fred S. Apple,Louise Cullen,Tone M Norekvål,Torbjørn Wisløff,Kjell Vikenes,Rune Bjørneklett,Torbjørn Omland,Kristin M. Aakre
出处
期刊:Annals of Emergency Medicine [Elsevier BV]
卷期号:86 (2): 124-135 被引量:11
标识
DOI:10.1016/j.annemergmed.2025.03.005
摘要

STUDY OBJECTIVE: To compare the effectiveness of high-sensitivity cardiac troponin (hs-cTn) point-of-care testing to central laboratory hs-cTn measurements when investigating patients presenting to the emergency department (ED) with symptoms of acute coronary syndrome. METHODS: The WESTCOR point-of-care study was a single-center prospective randomized controlled trial where we randomized patients presenting with possible acute coronary syndrome in a 1:1 fashion to receive either 0/1-hour centralized hs-cTnT measurements (control) or 0/1-hour point-of-care hs-cTnI testing (intervention). We defined length of stay (LOS) in the ED as the primary endpoint and the minimum clinically meaningful difference as 15 minutes. RESULTS: We included 1,494 patients in the final analysis, 728 in the point-of-care group, and 766 in the control group. The median (interquartile range) age was 61 (22) years, and 635 (42.5%) were women. Median LOS in the ED was 174 (95% confidence interval [CI] 167 to 181) and 180 (95% CI 175 to 189) minutes in the point-of-care and control group, respectively, resulting in a reduction in median LOS of 6 minutes (95% CI -4 to 17). Acute myocardial infarction, death, or acute revascularization occurred in 83/728 (11.4%) of point-of-care and 72/766 (9.4%) of control patients. CONCLUSIONS: We found that implementing point-of-care hs-cTnI testing in the ED with a 0/1-hour diagnostic algorithm did not lead to a clinically meaningful reduction in ED LOS. We observed no difference in the incidence of myocardial infarction, acute coronary revascularization, or death during 30 days follow-up.
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