Does a limit of detection and ECG discharge (LoDED) strategy improve early discharge without 30-day MACE in adult emergency department patients with chest pain compared to usual care?
A single undetectable high-sensitivity troponin combined with a non-ischaemic ECG facilitates safe early discharge in over 40% of emergency department patients with chest pain, though statistical superiority over usual care for the primary composite endpoint was not definitively established.
INTRODUCTION: The clinical effectiveness of a 'rule-out' acute coronary syndrome (ACS) strategy for emergency department patients with chest pain, incorporating a single undetectable high-sensitivity cardiac troponin (hs-cTn) taken at presentation, together with a non-ischaemic ECG, remains unknown. METHODS: A randomised controlled trial, across eight hospitals in the UK, aimed to establish the clinical effectiveness of an undetectable hs-cTn and ECG (limit of detection and ECG discharge (LoDED)) discharge strategy. Eligible adult patients presented with chest pain; the treating clinician intended to perform investigations to rule out an ACS; the initial ECG was non-ischaemic; and peak symptoms occurred 40% of patients with chest pain. Clinical effectiveness is variable when compared with existing rule-out strategies and influenced by wider system factors. TRIAL REGISTRATION NUMBER: ISRCTN86184521.
Carlton et al. (Tue,) studied this question.