Clinical outcomes for chest pain patients discharged home from emergency departments using high-sensitivity versus conventional cardiac troponin assays
High-sensitivity cardiac troponin (hs-cTn) assays enhance detection of lower circulating troponin concentrations, but the impact on outcomes in clinical practice is unclear. Our objective was to compare outcomes of chest pain patients discharged from emergency departments (EDs) using hs-cTn and conv...
Gespeichert in:
| Veröffentlicht in: | The American heart journal 2020-03, Vol.221, p.84-94 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 94 |
|---|---|
| container_issue | |
| container_start_page | 84 |
| container_title | The American heart journal |
| container_volume | 221 |
| creator | Lau, Geoffrey Koh, Maria Kavsak, Peter A. Schull, Michael J. Armstrong, David W.J. Udell, Jacob A. Austin, Peter C. Wang, Xuesong Ko, Dennis T. |
| description | High-sensitivity cardiac troponin (hs-cTn) assays enhance detection of lower circulating troponin concentrations, but the impact on outcomes in clinical practice is unclear. Our objective was to compare outcomes of chest pain patients discharged from emergency departments (EDs) using hs-cTn and conventional troponin (cTn) assays.
We conducted an observational study of chest pain patients aged 40-105 years who presented to an ED from April 1, 2013, to March 31, 2017, and were discharged home. We compared 30-day and 1-year outcomes of EDs that used hs-cTn versus cTn assays. The primary outcome was a composite of all-cause death, myocardial infarction or unstable angina. Comparisons were conducted with (1) no adjustment; (2) adjustment for demographic, socioeconomic, and hospital characteristics; and (3) full clinical adjustment.
Among the 394,910 patients, 62,138 (15.7%) were evaluated at hs-cTn EDs and 332,772 (84.3%) were evaluated at cTn EDs. Patients discharged from hs-cTn EDs were less likely to have diabetes, hypertension, or prior heart disease. At 30 days, the unadjusted primary outcome rate was lower in hs-cTn EDs (0.9% vs 1.0%, P |
| doi_str_mv | 10.1016/j.ahj.2019.12.007 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2341624008</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002870319303473</els_id><sourcerecordid>2341624008</sourcerecordid><originalsourceid>FETCH-LOGICAL-c311t-e94ef274f2638d3f6102c4356eb3d694387e586ce7c9a56a49cce2471f54051b3</originalsourceid><addsrcrecordid>eNp9kb-O1DAQhy0E4paDB6BBlmhoEvwvdiIqtAIO6SQaqC2vM9k4SuxgOyvtk_C6eNmDguIaWx59M6OfP4ReU1JTQuX7qTbjVDNCu5qymhD1BO0o6VQllRBP0Y4QwqpWEX6DXqQ0ladkrXyObjjtGsFZu0O_9rPzzpoZhy3bsEDCQ4jYjpAyXo3z5cgOfE64d8mOJh6hx2MB8RDDgmGBUvH2jHtYTczLH3RLzh_x6I5jlcAnl93J5TM-QUxbwjb4U8Fc8GWtNbF3xuIcwxp82WdSMuf0Ej0bzJzg1cN9i358_vR9f1fdf_vydf_xvrKc0lxBJ2BgSgxM8rbng6SEWcEbCQfey07wVkHTSgvKdqaRRnTWAhOKDo0gDT3wW_TuOneN4edWQuulxIR5Nh7CljTjgkomCGkL-vY_dApbLBkuVMM4UUKyQtErZWNIKcKg1-gWE8-aEn2xpiddrOmLNU2ZLtZKz5uHydthgf5fx19NBfhwBaB8xclB1MkWKRZ6F8Fm3Qf3yPjf1Xyq8A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2352307462</pqid></control><display><type>article</type><title>Clinical outcomes for chest pain patients discharged home from emergency departments using high-sensitivity versus conventional cardiac troponin assays</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>ProQuest Central UK/Ireland</source><creator>Lau, Geoffrey ; Koh, Maria ; Kavsak, Peter A. ; Schull, Michael J. ; Armstrong, David W.J. ; Udell, Jacob A. ; Austin, Peter C. ; Wang, Xuesong ; Ko, Dennis T.</creator><creatorcontrib>Lau, Geoffrey ; Koh, Maria ; Kavsak, Peter A. ; Schull, Michael J. ; Armstrong, David W.J. ; Udell, Jacob A. ; Austin, Peter C. ; Wang, Xuesong ; Ko, Dennis T.</creatorcontrib><description>High-sensitivity cardiac troponin (hs-cTn) assays enhance detection of lower circulating troponin concentrations, but the impact on outcomes in clinical practice is unclear. Our objective was to compare outcomes of chest pain patients discharged from emergency departments (EDs) using hs-cTn and conventional troponin (cTn) assays.
We conducted an observational study of chest pain patients aged 40-105 years who presented to an ED from April 1, 2013, to March 31, 2017, and were discharged home. We compared 30-day and 1-year outcomes of EDs that used hs-cTn versus cTn assays. The primary outcome was a composite of all-cause death, myocardial infarction or unstable angina. Comparisons were conducted with (1) no adjustment; (2) adjustment for demographic, socioeconomic, and hospital characteristics; and (3) full clinical adjustment.
Among the 394,910 patients, 62,138 (15.7%) were evaluated at hs-cTn EDs and 332,772 (84.3%) were evaluated at cTn EDs. Patients discharged from hs-cTn EDs were less likely to have diabetes, hypertension, or prior heart disease. At 30 days, the unadjusted primary outcome rate was lower in hs-cTn EDs (0.9% vs 1.0%, P < .001). The 30-day hazard ratios for the primary outcome were 0.84 (95% CI 0.77-0.92) for no adjustment and 0.98 (95% CI 0.88-1.08) for full adjustment. Over 1 year, patients discharged from hs-cTn EDs had significantly fewer primary outcomes (3.7% vs 4.1%, P < .001) and lower hazard ratio (0.93; 95% CI 0.89-0.98) even after full adjustment.
Hs-cTn testing was associated with a significantly lower adjusted hazard of myocardial infarction, angina, and all-cause hospitalization at 1 year but not 30 days.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2019.12.007</identifier><identifier>PMID: 31954328</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute Coronary Syndrome - complications ; Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - metabolism ; Adult ; Aged ; Aged, 80 and over ; Ambulatory care ; Angina ; Angina pectoris ; Angina, Unstable - epidemiology ; Assaying ; Calcium-binding protein ; Cardiovascular diseases ; Chest ; Chest Pain - etiology ; Clinical Laboratory Techniques - methods ; Clinical outcomes ; Comorbidity ; Coronary artery disease ; Diabetes ; Diabetes mellitus ; Emergency medical care ; Emergency medical services ; Emergency Service, Hospital ; FDA approval ; Female ; Health hazards ; Heart diseases ; Heart failure ; Hospitalization - statistics & numerical data ; Humans ; Hypertension ; Information systems ; Laboratories ; Male ; Middle Aged ; Mortality ; Myocardial infarction ; Myocardial Infarction - epidemiology ; Ontario - epidemiology ; Pain ; Patient Discharge ; Patients ; Personal health ; Population ; Prescription drugs ; Proportional Hazards Models ; Sensitivity ; Troponin ; Troponin I - analysis ; Troponin I - metabolism ; Troponin T - analysis ; Troponin T - metabolism</subject><ispartof>The American heart journal, 2020-03, Vol.221, p.84-94</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><rights>2019. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c311t-e94ef274f2638d3f6102c4356eb3d694387e586ce7c9a56a49cce2471f54051b3</citedby><cites>FETCH-LOGICAL-c311t-e94ef274f2638d3f6102c4356eb3d694387e586ce7c9a56a49cce2471f54051b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2352307462?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976,64364,64366,64368,72218</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31954328$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lau, Geoffrey</creatorcontrib><creatorcontrib>Koh, Maria</creatorcontrib><creatorcontrib>Kavsak, Peter A.</creatorcontrib><creatorcontrib>Schull, Michael J.</creatorcontrib><creatorcontrib>Armstrong, David W.J.</creatorcontrib><creatorcontrib>Udell, Jacob A.</creatorcontrib><creatorcontrib>Austin, Peter C.</creatorcontrib><creatorcontrib>Wang, Xuesong</creatorcontrib><creatorcontrib>Ko, Dennis T.</creatorcontrib><title>Clinical outcomes for chest pain patients discharged home from emergency departments using high-sensitivity versus conventional cardiac troponin assays</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>High-sensitivity cardiac troponin (hs-cTn) assays enhance detection of lower circulating troponin concentrations, but the impact on outcomes in clinical practice is unclear. Our objective was to compare outcomes of chest pain patients discharged from emergency departments (EDs) using hs-cTn and conventional troponin (cTn) assays.
We conducted an observational study of chest pain patients aged 40-105 years who presented to an ED from April 1, 2013, to March 31, 2017, and were discharged home. We compared 30-day and 1-year outcomes of EDs that used hs-cTn versus cTn assays. The primary outcome was a composite of all-cause death, myocardial infarction or unstable angina. Comparisons were conducted with (1) no adjustment; (2) adjustment for demographic, socioeconomic, and hospital characteristics; and (3) full clinical adjustment.
Among the 394,910 patients, 62,138 (15.7%) were evaluated at hs-cTn EDs and 332,772 (84.3%) were evaluated at cTn EDs. Patients discharged from hs-cTn EDs were less likely to have diabetes, hypertension, or prior heart disease. At 30 days, the unadjusted primary outcome rate was lower in hs-cTn EDs (0.9% vs 1.0%, P < .001). The 30-day hazard ratios for the primary outcome were 0.84 (95% CI 0.77-0.92) for no adjustment and 0.98 (95% CI 0.88-1.08) for full adjustment. Over 1 year, patients discharged from hs-cTn EDs had significantly fewer primary outcomes (3.7% vs 4.1%, P < .001) and lower hazard ratio (0.93; 95% CI 0.89-0.98) even after full adjustment.
Hs-cTn testing was associated with a significantly lower adjusted hazard of myocardial infarction, angina, and all-cause hospitalization at 1 year but not 30 days.</description><subject>Acute Coronary Syndrome - complications</subject><subject>Acute Coronary Syndrome - diagnosis</subject><subject>Acute Coronary Syndrome - metabolism</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Ambulatory care</subject><subject>Angina</subject><subject>Angina pectoris</subject><subject>Angina, Unstable - epidemiology</subject><subject>Assaying</subject><subject>Calcium-binding protein</subject><subject>Cardiovascular diseases</subject><subject>Chest</subject><subject>Chest Pain - etiology</subject><subject>Clinical Laboratory Techniques - methods</subject><subject>Clinical outcomes</subject><subject>Comorbidity</subject><subject>Coronary artery disease</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency Service, Hospital</subject><subject>FDA approval</subject><subject>Female</subject><subject>Health hazards</subject><subject>Heart diseases</subject><subject>Heart failure</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Information systems</subject><subject>Laboratories</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Ontario - epidemiology</subject><subject>Pain</subject><subject>Patient Discharge</subject><subject>Patients</subject><subject>Personal health</subject><subject>Population</subject><subject>Prescription drugs</subject><subject>Proportional Hazards Models</subject><subject>Sensitivity</subject><subject>Troponin</subject><subject>Troponin I - analysis</subject><subject>Troponin I - metabolism</subject><subject>Troponin T - analysis</subject><subject>Troponin T - metabolism</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kb-O1DAQhy0E4paDB6BBlmhoEvwvdiIqtAIO6SQaqC2vM9k4SuxgOyvtk_C6eNmDguIaWx59M6OfP4ReU1JTQuX7qTbjVDNCu5qymhD1BO0o6VQllRBP0Y4QwqpWEX6DXqQ0ladkrXyObjjtGsFZu0O_9rPzzpoZhy3bsEDCQ4jYjpAyXo3z5cgOfE64d8mOJh6hx2MB8RDDgmGBUvH2jHtYTczLH3RLzh_x6I5jlcAnl93J5TM-QUxbwjb4U8Fc8GWtNbF3xuIcwxp82WdSMuf0Ej0bzJzg1cN9i358_vR9f1fdf_vydf_xvrKc0lxBJ2BgSgxM8rbng6SEWcEbCQfey07wVkHTSgvKdqaRRnTWAhOKDo0gDT3wW_TuOneN4edWQuulxIR5Nh7CljTjgkomCGkL-vY_dApbLBkuVMM4UUKyQtErZWNIKcKg1-gWE8-aEn2xpiddrOmLNU2ZLtZKz5uHydthgf5fx19NBfhwBaB8xclB1MkWKRZ6F8Fm3Qf3yPjf1Xyq8A</recordid><startdate>202003</startdate><enddate>202003</enddate><creator>Lau, Geoffrey</creator><creator>Koh, Maria</creator><creator>Kavsak, Peter A.</creator><creator>Schull, Michael J.</creator><creator>Armstrong, David W.J.</creator><creator>Udell, Jacob A.</creator><creator>Austin, Peter C.</creator><creator>Wang, Xuesong</creator><creator>Ko, Dennis T.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202003</creationdate><title>Clinical outcomes for chest pain patients discharged home from emergency departments using high-sensitivity versus conventional cardiac troponin assays</title><author>Lau, Geoffrey ; Koh, Maria ; Kavsak, Peter A. ; Schull, Michael J. ; Armstrong, David W.J. ; Udell, Jacob A. ; Austin, Peter C. ; Wang, Xuesong ; Ko, Dennis T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c311t-e94ef274f2638d3f6102c4356eb3d694387e586ce7c9a56a49cce2471f54051b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Acute Coronary Syndrome - complications</topic><topic>Acute Coronary Syndrome - diagnosis</topic><topic>Acute Coronary Syndrome - metabolism</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Ambulatory care</topic><topic>Angina</topic><topic>Angina pectoris</topic><topic>Angina, Unstable - epidemiology</topic><topic>Assaying</topic><topic>Calcium-binding protein</topic><topic>Cardiovascular diseases</topic><topic>Chest</topic><topic>Chest Pain - etiology</topic><topic>Clinical Laboratory Techniques - methods</topic><topic>Clinical outcomes</topic><topic>Comorbidity</topic><topic>Coronary artery disease</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Emergency Service, Hospital</topic><topic>FDA approval</topic><topic>Female</topic><topic>Health hazards</topic><topic>Heart diseases</topic><topic>Heart failure</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Information systems</topic><topic>Laboratories</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Ontario - epidemiology</topic><topic>Pain</topic><topic>Patient Discharge</topic><topic>Patients</topic><topic>Personal health</topic><topic>Population</topic><topic>Prescription drugs</topic><topic>Proportional Hazards Models</topic><topic>Sensitivity</topic><topic>Troponin</topic><topic>Troponin I - analysis</topic><topic>Troponin I - metabolism</topic><topic>Troponin T - analysis</topic><topic>Troponin T - metabolism</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lau, Geoffrey</creatorcontrib><creatorcontrib>Koh, Maria</creatorcontrib><creatorcontrib>Kavsak, Peter A.</creatorcontrib><creatorcontrib>Schull, Michael J.</creatorcontrib><creatorcontrib>Armstrong, David W.J.</creatorcontrib><creatorcontrib>Udell, Jacob A.</creatorcontrib><creatorcontrib>Austin, Peter C.</creatorcontrib><creatorcontrib>Wang, Xuesong</creatorcontrib><creatorcontrib>Ko, Dennis T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lau, Geoffrey</au><au>Koh, Maria</au><au>Kavsak, Peter A.</au><au>Schull, Michael J.</au><au>Armstrong, David W.J.</au><au>Udell, Jacob A.</au><au>Austin, Peter C.</au><au>Wang, Xuesong</au><au>Ko, Dennis T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical outcomes for chest pain patients discharged home from emergency departments using high-sensitivity versus conventional cardiac troponin assays</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2020-03</date><risdate>2020</risdate><volume>221</volume><spage>84</spage><epage>94</epage><pages>84-94</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><abstract>High-sensitivity cardiac troponin (hs-cTn) assays enhance detection of lower circulating troponin concentrations, but the impact on outcomes in clinical practice is unclear. Our objective was to compare outcomes of chest pain patients discharged from emergency departments (EDs) using hs-cTn and conventional troponin (cTn) assays.
We conducted an observational study of chest pain patients aged 40-105 years who presented to an ED from April 1, 2013, to March 31, 2017, and were discharged home. We compared 30-day and 1-year outcomes of EDs that used hs-cTn versus cTn assays. The primary outcome was a composite of all-cause death, myocardial infarction or unstable angina. Comparisons were conducted with (1) no adjustment; (2) adjustment for demographic, socioeconomic, and hospital characteristics; and (3) full clinical adjustment.
Among the 394,910 patients, 62,138 (15.7%) were evaluated at hs-cTn EDs and 332,772 (84.3%) were evaluated at cTn EDs. Patients discharged from hs-cTn EDs were less likely to have diabetes, hypertension, or prior heart disease. At 30 days, the unadjusted primary outcome rate was lower in hs-cTn EDs (0.9% vs 1.0%, P < .001). The 30-day hazard ratios for the primary outcome were 0.84 (95% CI 0.77-0.92) for no adjustment and 0.98 (95% CI 0.88-1.08) for full adjustment. Over 1 year, patients discharged from hs-cTn EDs had significantly fewer primary outcomes (3.7% vs 4.1%, P < .001) and lower hazard ratio (0.93; 95% CI 0.89-0.98) even after full adjustment.
Hs-cTn testing was associated with a significantly lower adjusted hazard of myocardial infarction, angina, and all-cause hospitalization at 1 year but not 30 days.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31954328</pmid><doi>10.1016/j.ahj.2019.12.007</doi><tpages>11</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-8703 |
| ispartof | The American heart journal, 2020-03, Vol.221, p.84-94 |
| issn | 0002-8703 1097-6744 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2341624008 |
| source | MEDLINE; Elsevier ScienceDirect Journals; ProQuest Central UK/Ireland |
| subjects | Acute Coronary Syndrome - complications Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - metabolism Adult Aged Aged, 80 and over Ambulatory care Angina Angina pectoris Angina, Unstable - epidemiology Assaying Calcium-binding protein Cardiovascular diseases Chest Chest Pain - etiology Clinical Laboratory Techniques - methods Clinical outcomes Comorbidity Coronary artery disease Diabetes Diabetes mellitus Emergency medical care Emergency medical services Emergency Service, Hospital FDA approval Female Health hazards Heart diseases Heart failure Hospitalization - statistics & numerical data Humans Hypertension Information systems Laboratories Male Middle Aged Mortality Myocardial infarction Myocardial Infarction - epidemiology Ontario - epidemiology Pain Patient Discharge Patients Personal health Population Prescription drugs Proportional Hazards Models Sensitivity Troponin Troponin I - analysis Troponin I - metabolism Troponin T - analysis Troponin T - metabolism |
| title | Clinical outcomes for chest pain patients discharged home from emergency departments using high-sensitivity versus conventional cardiac troponin assays |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-17T11%3A49%3A13IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Clinical%20outcomes%20for%20chest%20pain%20patients%20discharged%20home%20from%20emergency%20departments%20using%20high-sensitivity%20versus%20conventional%20cardiac%20troponin%20assays&rft.jtitle=The%20American%20heart%20journal&rft.au=Lau,%20Geoffrey&rft.date=2020-03&rft.volume=221&rft.spage=84&rft.epage=94&rft.pages=84-94&rft.issn=0002-8703&rft.eissn=1097-6744&rft_id=info:doi/10.1016/j.ahj.2019.12.007&rft_dat=%3Cproquest_cross%3E2341624008%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2352307462&rft_id=info:pmid/31954328&rft_els_id=S0002870319303473&rfr_iscdi=true |