Accelerated Diagnostic Pathways for Suspected Acute Coronary Syndrome in Practice: A Randomized Trial of 0/1-Hour vs 0/3-Hour Troponin Testing.

In 30 seconds

This pragmatic randomized trial compared the 0/1-hour and 0/3-hour high-sensitivity troponin (hs-cTn) testing pathways for suspected acute coronary syndrome (ACS) in 3,543 patients across two emergency departments. The study found that the 0/1-hour pathway was noninferior in safety, with a +4.2% absolute difference in sensitivity (93.7% vs 89.5%) but did not significantly increase the proportion of patients discharged within 4 hours (21.8% vs 19.2%, P = 0.07).

Key findings

• The 0/1-hour pathway had a sensitivity of 93.7% compared to 89.5% for the 0/3-hour pathway.
• Only 21.8% of patients were discharged within 4 hours using the 0/1-hour pathway.
• The absolute difference in safety was +4.2% in favor of the 0/1-hour pathway.
• The median turnaround time for hs-cTnT results was 81 minutes.

Why it matters

Understanding the efficiency and safety of different troponin testing pathways is crucial for optimizing patient management in emergency settings. This study highlights the challenges in achieving timely discharges despite advancements in testing protocols.