Single-sample rule-out pathway
Research type
Research Study
Full title
Optimisation of Single-sample Rule-Out Pathway using high-sensitivity cardiac Troponin for suspected acute coronary syndrome: an observational study to assess whether an optimised pathway can improve safe early discharge of patients with suspected acute coronary syndrome
IRAS ID
355205
Contact name
Nicholas Mills
Contact email
Sponsor organisation
University of Edinburgh
Duration of Study in the UK
1 years, 0 months, 29 days
Research summary
Most patients who went to the Emergency Department with chest pain do not have a heart attack. This places a huge burden on the healthcare system and strains already limited resources. Using safe and effective methods to identify low-risk patients and discharge them early from the hospital would greatly improve patients’ experience and reduce costs for healthcare providers.
During a heart attack, heart cells are damaged and release a protein called troponin into the blood. By testing blood for troponin, doctors can decide whether someone is having a heart attack. Using a highly sensitive blood test for troponin, doctors have developed a method to send patients at low risk for heart attack safely home with just one blood test. This is called a one-sample method. We previously tested this method in 31,000 patients with chest pain. By setting the level of troponin considered low risk for heart attack low, we reduced the time patients spent in the hospital by 3 hours and safely discharged 20% more patients.
In this study, we propose two further improvements on the original one-sample method. First, we propose an even lower threshold for identifying lower risk patients with chest pain for less than 2 hours. Second, we propose optimal timing of a second blood test in patients who required two blood tests. Using datasets from multiple studies across different countries, we will assess if the proposed change is safe and more effective in discharging low risk patients in different populations.
REC name
South East Scotland REC 02
REC reference
25/SS/0033
Date of REC Opinion
22 Apr 2025
REC opinion
Favourable Opinion