Erez Marcusohn1, Danny Epstein2, Ariel Roguin3,4, Robert Zukermann1. 1. Department of Cardiology, Rambam Health Care Campus, Haifa, Israel. 2. Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel. 3. Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel. 4. Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology.
Abstract
INTRODUCTION: Patients presenting to the emergency department (ED) with cardiac chest pain and high sensitive troponin I (HsTn) less than 5 ng/L have very good prognosis and low risk for major adverse cardiovascular events (MACE).The 2015 ESC guidelines for Non ST elevation myocardial infarction (MI)/Acute coronary syndrome (ACS) suggests that patients with normal HsTn, that are free of chest pain and have a GRACE Score less than 140 are eligible for discharge from the hospital for outpatient workup.Our hypothesis suggests that not all patients with GRACE score under 140 should be discharged for ambulatory tests even with undetectable HsTnI as recommended in the guidelines. METHODS: Population-based retrospective cohort study in a large tertiary care center. The study population included all patients discharged from the hospital between February 1, 2016 and February 28, 2019 following rule out of MI. RESULTS: During the study period, a total of 13,800 patients were discharged from the hospital after rule out of MI. Among them, 9236 (67%) had HsTnI below 5ng/L. A total of 7705 patients (83%) met the criteria for low (n = 7162) or moderate (n = 543) GRACE risk score. Moderate risk patients had significantly more adverse events than low-risk patients (4.6% vs. 2.1%, p < 0.001). They are in higher risk of death (0.5% vs. 0.1%, p = 0.042), revascularization (3.9% vs. 1.8%, p = 0.0047) and readmission due to ACS (1.1% vs. 0.4%, p = 0.031). CONCLUSIONS: Patients presenting to the ED with chest pain and HsTnI less than 5 ng/l and GRACE score under 140 have 2-4% adverse event in 60 days. The differences between the groups suggest using rapid rule out algorithms for only low-risk patients with GRACE score under 73. Published on behalf of the European Society of Cardiology. All rights reserved.
INTRODUCTION:Patients presenting to the emergency department (ED) with cardiac chest pain and high sensitive troponin I (HsTn) less than 5 ng/L have very good prognosis and low risk for major adverse cardiovascular events (MACE).The 2015 ESC guidelines for Non ST elevation myocardial infarction (MI)/Acute coronary syndrome (ACS) suggests that patients with normal HsTn, that are free of chest pain and have a GRACE Score less than 140 are eligible for discharge from the hospital for outpatient workup.Our hypothesis suggests that not all patients with GRACE score under 140 should be discharged for ambulatory tests even with undetectable HsTnI as recommended in the guidelines. METHODS: Population-based retrospective cohort study in a large tertiary care center. The study population included all patients discharged from the hospital between February 1, 2016 and February 28, 2019 following rule out of MI. RESULTS: During the study period, a total of 13,800 patients were discharged from the hospital after rule out of MI. Among them, 9236 (67%) had HsTnI below 5ng/L. A total of 7705 patients (83%) met the criteria for low (n = 7162) or moderate (n = 543) GRACE risk score. Moderate risk patients had significantly more adverse events than low-risk patients (4.6% vs. 2.1%, p < 0.001). They are in higher risk of death (0.5% vs. 0.1%, p = 0.042), revascularization (3.9% vs. 1.8%, p = 0.0047) and readmission due to ACS (1.1% vs. 0.4%, p = 0.031). CONCLUSIONS:Patients presenting to the ED with chest pain and HsTnI less than 5 ng/l and GRACE score under 140 have 2-4% adverse event in 60 days. The differences between the groups suggest using rapid rule out algorithms for only low-risk patients with GRACE score under 73. Published on behalf of the European Society of Cardiology. All rights reserved.