{"id":"9acb626872e2","type":"article","url":"https://hartvaat.nl/2020/10/01/troponine-grenswaarde-ontslagstrategie-versus-standaardzorg-gerandomiseerde-tria/","title":"Troponine-grenswaarde ontslagstrategie versus standaardzorg: gerandomiseerde trial","title_en":"Limit of detection of troponin discharge strategy versus usual care: randomised controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2020-316692","source_url":"https://doi.org/10.1136/heartjnl-2020-316692","authors":["Edward Watts Carlton","Jenny Ingram","Hazel Taylor","Joel Glynn","Rebecca Kandiyali","Sarah Campbell","Lucy Beasant","Shahid Aziz","Peter Beresford","Jason Kendall","Adam Reuben","Jason E Smith","Rebecca Chapman","Siobhan Creanor","Jonathan Richard Benger"],"significance":7,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial showed that a troponin limit-of-detection discharge strategy safely reduces emergency department length of stay in patients with suspected ACS, without increasing adverse events.","created":"2026-07-03T10:28:46Z","updated":"2026-07-03T13:27:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die een troponine limit-of-detection ontslagstrategie vergeleek met standaardzorg bij verdenking ACS.","abstract_original":"INTRODUCTION: The 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. METHODS: A 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. RESULTS: Between 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. CONCLUSION: The 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."}