Safety and efficacy of the 0 h/3 h protocol for rapid rule out of myocardial infarction

Multi-centre evaluation of recent troponin assays for the diagnosis of NSTEMI

“…This specificity was significantly superior to a single measurement strategy for HS-assays, cTnI-Pathfast, cTnI-Ultra and cTnI-Vista. Our results are comparable to those in the literature when considering HS assays [6] , [17] , [18] , [22] , [30] , but also cTnI Access, cTnI-Vista, cTnI-Vitros, cTnI-AQT [5] , [7] , [14] , [30] , and cTnT-AQT [19] , [30] , although comparison is limited because of the sample size of the population and study protocols (some data in the literature is reported for H0-H2). Moreover, the percentage of rule-out patients with these H0-H3 strategies is elevated for all assays.…”

“…The literature is scarce concerning studies measuring several cTn assays in a single population. Wildi et al recently reported data on 4 HS assays and 3 sensitive assays [6] , but some assays were in a pre-commercial version. Here, we report data on fully commercial and routinely used HS, sensitive and POC assays, which we compare to the literature.…”

“…Due to the absence of standardisation, troponin results cannot be transferred from one assay to another, and individual cut-offs must be strictly used in the context of the troponin assay for which they were determined [4] . Few studies indicate delta change values for cTn assays in a single population, but most are reported for HS-cTn methods [3] , [5] , [6] , [7] .…”

Can a Negative High-Sensitivity Troponin Result Rapidly Rule Out Acute Myocardial Infarction?

“…Current evidence suggests that usual care with conventional cTn assays 5 or a single sensitive troponin assay may be as effective as hs-cTnT when patients are appropriately stratified as being at low risk for acute myocardial infarction. 6 However, owing to a wide practice variation for an "acceptable miss rate" 7 and diverse causes for presenting symptoms, 8 admission for serial cTn and provocative testing is common. 1 Implementation of hs-cTnT may enable patients to be safely discharged from the ED earlier than in current practice; however, the reduced specificity may negate the benefits of ED throughput by increasing hospital admission, health care spending, and invasive interventions.…”

The influence of information structuring and health literacy on recall and satisfaction in a simulated discharge communication

“…As a result of ever increasing time constraints, patient-centred communication is severely under pressure. Scientific advances have accelerated diagnostic pathways and rendered possible 'fast-track' emergency care, such as the rapid exclusion of myocardial infarction [10]. Therefore, an expeditious diagnostic process needs to be matched by timely and efficient discharge communication.…”