急诊疑似ACS患者使用床旁高敏肌钙蛋白检测缩短留观时间：阶梯楔形整群随机试验

原文

BACKGROUND: Point-of-care high-sensitivity cTn (cardiac troponin; hs-cTn) testing has the potential to expedite decision-making and reduce emergency department (ED) length of stay for patients presenting with possible myocardial infarction by ensuring that results are consistently available when sought by clinicians. We assessed the real-life effectiveness and safety of implementing point-of-care hs-cTn testing in the ED. METHODS: We conducted a pragmatic, stepped-wedge cluster-randomized trial. The control arm was usual care with an accelerated diagnostic pathway using a single-sample rule-out step with a central laboratory hs-cTn assay. The intervention arm used the same pathway with a point-of-care hs-cTnI assay. The primary effectiveness outcome was ED length of stay assessed using a generalized linear mixed model. The safety outcome was myocardial infarction or cardiac death within 30 days. RESULTS: Six sites participated, with 59 980 ED presentations (44 747 individuals; mean 61±19 years of age; 49.5% female) from February 2023 through January 2025; 31 392 presentations were during the intervention arm. After adjustment for covariates associated with length of stay, the intervention reduced length of stay by 13% (95% CI, 9%-16%; P<0.001), corresponding to a reduction of 47 minutes (95% CI, 33-61 minutes) from a mean length of stay in the control arm of 376 minutes. The 30-day myocardial infarction or cardiac death rate was similar in the control and intervention arms (0.39% and 0.39%, respectively; P=0.54). CONCLUSIONS: Implementation of whole-blood hs-cTnI testing at the point of care into an accelerated diagnostic pathway was safe and reduced length of stay in the ED compared with laboratory testing. REGISTRATION: URL: https://www.anzctr.org.au; Unique identifier: ACTRN12619001189112.