Key result
Presentation to an urban university maximum care facility was associated with faster baseline cardiac troponin result announcement compared to a rural primary care facility (26.5 vs 33.0 minutes, p=0.02).
Why the study?
Does management in an urban university maximum care chest pain unit compared to a rural regional primary care facility improve the timing of cardiac troponin measurements and invasive management in patients with NSTE-ACS?
Observational (n=164)
Yes
Does management in an urban university maximum care chest pain unit compared to a rural regional primary care facility improve the timing of cardiac troponin measurements and invasive management in patients with NSTE-ACS?
Absolute Event Rate: 26.5% vs 33%
p-value: p=0.02
German chest pain units provide timely, guideline-adherent identification of cTn-positive patients, with comparable early cTn timing and invasive management rates between urban maximum care and rural primary care facilities.
May inform urban-rural process optimization in chest pain units; hypothesis-generating for NSTE-ACS outcome effects.
AIM: To analyse the timing of cardiac troponin (cTn) measurements in high-risk and cTn-positive acute coronary syndromes without persistent ST-segment elevation (NSTE-ACS) in two structurally different German chest pain units (CPUs), contrasting an urban university maximum care and a rural regional primary care facility. METHODS: All patients encoded as NSTEMI during the year 2013 were retrospectively enrolled in two centres: site (I)--centre of maximum care in an urban university setting and site (II)--centre of primary care in a rural regional care setting. Data acquisition included time intervals from admission to baseline cTn and first and second cTn control as well as type and timing of invasive management. RESULTS: The median times (site I vs. site II) from admission to cTn result announcement were 26.5 vs. 33.0 min (p = 0.02) for baseline, 4 vs. 4 h (p = 0.43) for the first and 11.0 vs. 16.5 h (p = 0.03) for the second control. Timely announcement, as recommended by guidelines, was available in 86.9% at baseline, 59.4% for the first or 41.1% for the second cTn control. Rates and timing of invasive management were independent from the time point of positive cTn announcement (p = 0.51 and p = 0.68, respectively). CONCLUSIONS: German CPUs provide timely identification of cTn-positive patients in a narrow and guideline-adherent time frame using a rapid rule-out protocol. Especially, baseline and early cTn timing was comparable between the urban university maximum care and the rural regional primary care facility without relevant impact on guideline-conforming invasive management, underlining the high standard of care in those highly professional institutions.
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Fischer et al. (2016) conducted an observational in Acute coronary syndromes without persistent ST-segment elevation (NSTE-ACS) (n=164). Urban university maximum care facility vs. Rural regional primary care facility was evaluated on Median time from admission to baseline cardiac troponin result announcement (minutes) (p=0.02). Presentation to an urban university maximum care facility was associated with faster baseline cardiac troponin result announcement compared to a rural primary care facility (26.5 vs 33.0 minutes, p=0.02).
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