دورية أكاديمية
High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial.
| العنوان: | High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial. |
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| المؤلفون: | Shah, ASV, Anand, A, Strachan, FE, Ferry, AV, Lee, KK, Chapman, AR, Sandeman, D, Stables, CL, Adamson, PD, Andrews, JPM, Anwar, MS, Hung, J, Moss, AJ, O'Brien, R, Berry, C, Findlay, I, Walker, S, Cruickshank, A, Reid, A, Gray, A, Collinson, PO, Apple, FS, McAllister, DA, Maguire, D, Fox, KAA, Newby, DE, Tuck, C, Harkess, R, Parker, RA, Keerie, C, Weir, CJ, Mills, NL, High-STEACS Investigators |
| بيانات النشر: | Elsevier |
| سنة النشر: | 2018 |
| المجموعة: | St George's University of London: Repository |
| الوصف: | BACKGROUND: High-sensitivity cardiac troponin assays permit use of lower thresholds for the diagnosis of myocardial infarction, but whether this improves clinical outcomes is unknown. We aimed to determine whether the introduction of a high-sensitivity cardiac troponin I (hs-cTnI) assay with a sex-specific 99th centile diagnostic threshold would reduce subsequent myocardial infarction or cardiovascular death in patients with suspected acute coronary syndrome. METHODS: In this stepped-wedge, cluster-randomised controlled trial across ten secondary or tertiary care hospitals in Scotland, we evaluated the implementation of an hs-cTnI assay in consecutive patients who had been admitted to the hospitals' emergency departments with suspected acute coronary syndrome. Patients were eligible for inclusion if they presented with suspected acute coronary syndrome and had paired cardiac troponin measurements from the standard care and trial assays. During a validation phase of 6-12 months, results from the hs-cTnI assay were concealed from the attending clinician, and a contemporary cardiac troponin I (cTnI) assay was used to guide care. Hospitals were randomly allocated to early (n=5 hospitals) or late (n=5 hospitals) implementation, in which the high-sensitivity assay and sex-specific 99th centile diagnostic threshold was introduced immediately after the 6-month validation phase or was deferred for a further 6 months. Patients reclassified by the high-sensitivity assay were defined as those with an increased hs-cTnI concentration in whom cTnI concentrations were below the diagnostic threshold on the contemporary assay. The primary outcome was subsequent myocardial infarction or death from cardiovascular causes at 1 year after initial presentation. Outcomes were compared in patients reclassified by the high-sensitivity assay before and after its implementation by use of an adjusted generalised linear mixed model. This trial is registered with ClinicalTrials.gov, number NCT01852123. FINDINGS: Between June 10, 2013, and ... |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | application/pdf |
| اللغة: | English |
| العلاقة: | https://openaccess.sgul.ac.uk/id/eprint/110188/1/1-s2.0-S0140673618319238-main.pdfTest; Shah, ASV; Anand, A; Strachan, FE; Ferry, AV; Lee, KK; Chapman, AR; Sandeman, D; Stables, CL; Adamson, PD; Andrews, JPM; et al. Shah, ASV; Anand, A; Strachan, FE; Ferry, AV; Lee, KK; Chapman, AR; Sandeman, D; Stables, CL; Adamson, PD; Andrews, JPM; Anwar, MS; Hung, J; Moss, AJ; O'Brien, R; Berry, C; Findlay, I; Walker, S; Cruickshank, A; Reid, A; Gray, A; Collinson, PO; Apple, FS; McAllister, DA; Maguire, D; Fox, KAA; Newby, DE; Tuck, C; Harkess, R; Parker, RA; Keerie, C; Weir, CJ; Mills, NL; High-STEACS Investigators (2018) High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial. Lancet, 392 (10151). pp. 919-928. ISSN 1474-547X https://doi.org/10.1016/S0140-6736Test(18)31923-8 SGUL Authors: Collinson, Paul |
| الإتاحة: | https://doi.org/10.1016/S0140-6736Test(18)31923-8 https://openaccess.sgul.ac.uk/id/eprint/110188Test/ https://openaccess.sgul.ac.uk/id/eprint/110188/1/1-s2.0-S0140673618319238-main.pdfTest |
| حقوق: | cc_by_4 |
| رقم الانضمام: | edsbas.1AE4416E |
| قاعدة البيانات: | BASE |
| الوصف غير متاح. |