Key result
A 2-hour ADP is linked to ~76% lower 30-day MACE versus a 6-hour protocol.
Why the study?
Rapid decision making in managing chest pain suspected for ACS is important to reduce hospital stay and financial burden, but the comparative effectiveness of a 2-hour accelerated diagnostic protocol versus current practice was unclear.
Does a 2-hour accelerated diagnostic protocol reduce 30-day major adverse cardiac events compared to a 6-hour protocol in low-risk patients with possible cardiac chest pain?
Cohort (n=900)
Odd or even days at admission time
No
Does a 2-hour accelerated diagnostic protocol reduce 30-day major adverse cardiac events compared to a 6-hour protocol in low-risk patients with possible cardiac chest pain?
Odds Ratio: 4.1 (95% CI 1.23–13.81)
Absolute Event Rate: 1% vs 4%
p-value: p=0.01
A 2-hour accelerated diagnostic protocol for low-risk chest pain patients is associated with fewer 30-day major adverse cardiac events compared to a standard 6-hour protocol.
2-hour ADP was associated with fewer 30-day MACE vs current protocol; hypothesis-generating and requires randomized trials before practice change.
BACKGROUND: Chest pain indicating acute coronary syndrome (ACS) accounts for approximately 5-10% of presents in the emergency departments (EDs). Rapid decision making is very important because longer hospital stay is associated with higher financial burden. The aim of this study was to compare current practice with a 2-hour accelerated diagnostic protocol (ADP) to manage chest pain in patients suspected to have ACS. METHODS: This is a longitudinal follow-up study on 900 patients with negative troponin measured on entrance to the ED and initially low-risk for myocardial infarction according to the emergency department of chest pain assessment score (EDACS) at the Loghman Hakim Hospital, Tehran, Iran in 2018. Patients were divided in two groups (based on odd or even days at admission time) at a ratio of 2:1 (i) current protocol with a second troponin measuring after 6 hours and (ii) ADP with a second troponin measured after 2 hours. Major adverse cardiac events (MACE) associated factors assessed in two groups over 30-days. RESULTS: Totally, the rate of return to EDs with the major adverse cardiac events was 4% (n=24) in the current protocol group and 1% (n=1) in the ADP group within 30 days. The odds ratio for MACE in 30 days in the current protocol was 4.3 times more than ADP group (95% CI: 1.28-14.56, OR: 4.33, p:0.02). In multivariable logistic regression analysis, this estimation for the current protocol was 4.10 times more than comparison group (95% CI: 1.23-13.81, OR: 4.10, p:0.01). CONCLUSION: A 2-hour ADP in patients at low-risk for myocardial infarction by EDACS had fewer adverse follow-up events than the current protocol.
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Heidari et al. (2021) conducted a cohort in Possible cardiac chest pain suspected to have acute coronary syndrome (n=900). 2-hour accelerated diagnostic protocol (ADP) vs. Current protocol with a second troponin measuring after 6 hours was evaluated on Major adverse cardiac events (MACE) within 30 days (OR 4.10, 95% CI 1.23-13.81, p=0.01). A 2-hour accelerated diagnostic protocol for low-risk chest pain resulted in fewer 30-day major adverse cardiac events compared to a 6-hour protocol (1% vs 4%; current protocol OR 4.10, p=0.01).
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