Trial reportHeart (British Cardiac Society)2020
Limit of detection of troponin discharge strategy versus usual care: randomised controlled trial.
Trial report in Heart (British Cardiac Society), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pooled it
- 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee.Journal of the American College of Cardiology · 2022Guideline
- Health Care Resource Utilization for Patients With Suspected Myocardial Infarction: A Secondary Analysis of the RACE-IT Randomized Clinical Trial.JAMA network open · 2025Trial
- Trial
- The Evolution of Accelerated Diagnostic Protocols for Suspected Myocardial Infarction.Journal of clinical medicine · 2026Review
- Early Rule Out of Myocardial Infarction With a Novel High-Sensitivity Cardiac Troponin T Assay.JAMA cardiology · 2026Article
- Computerized Self-Reported Medical History Taking to Support Early Rule Out of Major Adverse Cardiac Events in Patients With Acute Chest Pain: Post Hoc Analysis of the CLEOS-CPDS Prospective Cohort Study.Journal of medical Internet research · 2026Observational
- Brazilian Guideline for the Evaluation and Diagnosis of Chest Pain in the Emergency Department - 2025.Arquivos brasileiros de cardiologia · 2025Article
- Evaluation of sex-specific 0-h high-sensitivity cardiac troponin T thresholds for the risk stratification of non-ST-segment elevation myocardial infarction.Clinical chemistry and laboratory medicine · 2025Article
- High-Sensitivity Cardiac Troponin Assays: From Implementation to Resource Utilization and Cost Effectiveness.The journal of applied laboratory medicine · 2025Review
- Single high-sensitivity troponin-I for ruling out acute coronary syndrome: a detection limit approach.European heart journal open · 2024Article
- Adoption of high-sensitivity cardiac troponin for risk stratification of patients with suspected myocardial infarction: a multicentre cohort study.The Lancet regional health. Europe · 2024Article
- How to Approach Patients with Acute Chest Pain.Reviews in cardiovascular medicine · 2024Review
- Validation of Becton Dickinson BarricorEJIFCC · 2024Article
- Complications in Emergency Department Patients with Acute Coronary Syndrome with Contemporary Care.Cardiology · 2024Observational
- A Single High-Sensitivity Cardiac Troponin T Strategy for Ruling Out Myocardial Infarction.Emergency medicine international · 2024Article
- Independent Predictors of Repeat Emergency Room Presentations: Insights from a Cohort of 1066 Consecutive Patients with Non-Cardiac Chest Pain Generating 4770 Repeat Presentations.Journal of clinical medicine · 2023Article
- Troponin in early presenters to rule out myocardial infarction.European heart journal · 2023Article
- Machine learning for diagnosis of myocardial infarction using cardiac troponin concentrations.Nature medicine · 2023Article
- Article
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Authors and funding
15 authors.
Funding
Abstract
introductionThe clinical effectiveness of a 'rule-out' acute coronary syndrome (ACS) strategy for emergency department patients with chest pain, incorporating a single undetectable high-sensitivity cardiac troponin (hs-cTn) taken at presentation, together with a non-ischaemic ECG, remains unknown.
methodsA randomised controlled trial, across eight hospitals in the UK, aimed to establish the clinical effectiveness of an undetectable hs-cTn and ECG (limit of detection and ECG discharge (LoDED)) discharge strategy. Eligible adult patients presented with chest pain; the treating clinician intended to perform investigations to rule out an ACS; the initial ECG was non-ischaemic; and peak symptoms occurred <6 hours previously. Participants were randomised 1:1 to either the LoDED strategy or the usual rule-out strategy. The primary outcome was discharge from the hospital within 4 hours of arrival, without a major adverse cardiac event (MACE) within 30 days.
resultsBetween June 2018 and March 2019, 632 patients were randomised; 3 were later withdrawn. Of 629 patients (age 53.8 (SD 16.1) years, 41% women), 7% had a MACE within 30 days. For the LoDED strategy, 141 of 309 (46%) patients were discharged within 4 hours, without MACE within 30 days, and for usual care, 114 of 311 (37%); pooled adjusted OR 1.58 (95% CI 0.84 to 2.98). No patient with an initial undetectable hs-cTn had a MACE within 30 days.
conclusionThe LoDED strategy facilitates safe early discharge in >40% of patients with chest pain. Clinical effectiveness is variable when compared with existing rule-out strategies and influenced by wider system factors. TRIAL REGISTRATION NUMBER: ISRCTN86184521.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.