Why the study?
The clinical effectiveness of an ACS rule-out strategy using a single undetectable hs-cTn at presentation with a non-ischaemic ECG in emergency department chest pain patients remained unknown.
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?
Population
629 adult emergency department patients presenting with chest pain to rule out ACS
Comparison
LoDED discharge strategy vs usual rule-out strategy
Design
Multicentre 1:1 randomised controlled trial across eight hospitals
Follow-up
30 days
Authors
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Supports safety of undetectable hs-cTn for early discharge; leaves open need for larger trials to confirm benefit over usual care.
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.
Carlton et al. (2020) studied this question.
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