A single centre prospective cohort study addressing the effect of a rule-in/rule-out troponin algorithm on routine clinical practice

Abstract

Introduction of a 0 hour 'rule-in' and 'rule-out' algorithm in routine clinical practice enables rapid triage of 48% of patients, and is associated with more rapid repeat testing in intermediate risk patients.

Cardiac Myosin-Binding Protein C: How a Novel Biomarker Could Transform Chest Pain Triage

“…At similar diagnostic accuracy (based on comparable area under the receiver-operating characteristics curve), cMyC was substantially more effective than either hs-cTn assay in guiding patients to (safe) rule-out or rule-in: the net reclassification improvement demonstrated 14.9-23.5% better triage efficiency, thus reducing the size of the 'observe' zone substantially. In an institution such as St Thomas' Hospital, a central London hospital home to a tertiary cardiac unit, about 7800 patients are subject to hs-cTnT testing in the emergency department annually [23]. Our findings would translate into savings of 1000 bed-days per year -simply by achieving a more effective triage with a single blood draw at presentation.…”

The HEART score in the era of the European Society of Cardiology 0/1-hour algorithm

“…The safety and efficacy of the ESC 0/1-h algorithm has been demonstrated in various studies. 11,12,[31][32][33][34] However, the algorithm only considers blood concentrations of a cardiac biomarker when considering early discharge or outpatient management and does not consider other clinical risk factors that increase the probably of having cardiovascular events. Furthermore, the ESC 0/1-h algorithm can triage patients towards "rule-out" who, despite having ACS, do not present with elevated cardiac biomarkers, namely patients with unstable angina.…”

A triptych on acute cardiovascular care

“…Introduction in routine clinical practice at a large London hospital of a 0-hour 'rule-out' and 'rule-in' algorithm based on a single hs-cTn measurement on admission enabled rapid triage of 48% of patients as low-risk and to rule-in 5% as high-risk. 2 A large meta-analysis on the accuracy of diagnostic tests for patients presenting with chest pain to the ED confirms the advantage of rapid rule-out algorithms using hs-cTn assays. Among the non-invasive ischemia tests used in lowrisk patients without increased hs-cTn, coronary computed tomography angiography scored the highest diagnostic accuracy while exercise electrocardiogram (ECG) testing the lowest.…”

“…Introduction in routine clinical practice at a large London hospital of a 0-hour ‘rule-out’ and ‘rule-in’ algorithm based on a single hs-cTn measurement on admission enabled rapid triage of 48% of patients as low-risk and to rule-in 5% as high-risk. 2…”