A 2-Hour Diagnostic Protocol for Possible Cardiac Chest Pain in the Emergency Department

Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay

“…Thereby, the high-sensitivity cardiac troponin T 1-hour algorithm was even more effective in the early triage of patients with acute chest pain than, for example, the recently developed accelerated diagnostic protocol combining the Thrombolysis in Myocardial Infarction Score with high-sensitivity cardiac troponin levels at baseline and 2 hours, or the dual-marker approach combining high-sensitivity cardiac troponin with copeptin, which assign 20%-40% of patients for rapid rule-out. [20][21][22][23][24][25][26][27] This difference is at least partly explained by the fact that the latter approaches exclusively select patients for rule-out, but do not provide guidance for rule-in.…”

The utility of presentation and 4-hour high sensitivity troponin I to rule-out acute myocardial infarction in the emergency department

“…Patients were recruited in conjunction with a randomised controlled trial comparing an 'accelerated' (2 hour) chest pain diagnostic pathway against the standard investigative process at Christchurch Hospital. This trial has been described in detail elsewhere [8] This analysis was limited to patients with sufficient stored plasma sample available for hs-cTnI assay at both presentation and 4 hours. with at least one value above the 99th percentile (28 ng/L).…”

“…A second measurement of hs-cTn from a blood sample drawn two to four-hours after hospital attendance time-point may be useful. Whereas accelerated chest pain pathways incorporating presentation and 2h sampling can identify an increased proportion of low-risk patients [8,9] a presentation and 3h or 4h timeframe is still short enough so that patients could remain in the ED under the care of the original clinicians without transfer to another hospital area or handover to other staff.…”

Discharge of Non–Acute Coronary Syndrome Chest Pain Patients From Emergency Care to an Advanced Nurse Practitioner–Led Chest Pain Clinic

“…8 Recently specific protocols and practices have been developed to facilitate direct discharge from the ED. These range from; a two-hour accelerated diagnostic protocol (ADP) 10,11 a chest pain diagnostic algorithm facilitating discharge followed by outpatient stress testing within 48 hours 12 the New Vancouver chest pain prediction rule 13,14 ; and chest pain patients discharged from ED who underwent exercise stress testing within one week of discharge. 15 Collectively these studies showed the reduced need for lengthy assessment and suitability for early ED discharge whilst maintaining a low rate of patients experiencing a MACE (major adverse cardiac event) of 0-2.8 % at 30 days.…”

“…15 Collectively these studies showed the reduced need for lengthy assessment and suitability for early ED discharge whilst maintaining a low rate of patients experiencing a MACE (major adverse cardiac event) of 0-2.8 % at 30 days. [10][11][12][13][14][15] These studies contain a small number of patients in relation to the numbers of chest pain presentations to the health care system and mainly focus on ADP development, MACE and ACS outcomes with physician led models. There is a lack of published data on the outcome and final diagnosis of non-ACS patients discharged directly from ED and the application of alternative models of care.…”