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Revista argentina de cardiología
versão On-line ISSN 1850-3748
Resumo
SPROCKEL, JOHN J. et al. Accelerated Diagnostic Protocols Based on High-Sensitivity Troponin in the Diagnosis of Thoracic Pain: A Systematic Review. Rev. argent. cardiol. [online]. 2023, vol.91, n.4, pp.290-297. Epub 01-Ago-2023. ISSN 1850-3748. http://dx.doi.org/10.7775/rac.es.v91.i4.20662.
Background:
Accelerated diagnostic protocols for chest pain, with the advancement of high-sensitivity troponin, make it possible to identify patients admitted to the emergency department with chest pain and low risk for a major adverse cardiovascular event, who could be discharged immediately, early and safely, saving time and resources.
Objective:
The aim of this study was to assess clinical trials using accelerated diagnostic protocols based on high-sensitivity troponin.
Methods:
A search of randomized clinical trials evaluating accelerated diagnostic protocols based on high-sensitivity troponin in emergency services was carried out in MEDLINE/Ovid, Cochrane and EMBASE database, using the assessment criteria of the Cochrane manual and the PRISMA strategy.
Results:
After screening 3509 studies, 5 clinical trials, including 1513 patients, were analyzed. Early discharges were identified in 409 (27%) of patients, in 91% of cases for ESC 0/3-h protocols, 72% for 0/1-h, 48% for EDACS, 40% for HEART, 19% and 32% for ADAPT and 8% and 18% for standard care protocols. The negative predictive value was high, in the 99.1-100% range. Mean length of hospital stay was lower for the 0/1-h and ESC 0/3-h protocols, with 4.6 and 5.6 hours, respectively.
Conclusions:
Accelerated diagnostic protocols in chest pain using high-sensitivity troponin allow a higher proportion of early discharges with a low rate of major cardiovascular events, with reduction in length of hospital stay and resources used.
Palavras-chave : Thoracic pain; Accelerated diagnostic protocols; High-sensitivity troponin; Acute coronary syndrome; Acute myocardial infarction; Coronary disease.