Diagnosis and Treatment of ACS in the ED: The Impact of Rapid Bedside cTnI Testing on Outcomes
Diagnosis and Treatment of ACS in the ED: The Impact of Rapid Bedside cTnI Testing on Outcomes
In a randomized, controlled clinical trial, point-of care testing at the bedside using the
 cardiac biomarker troponin I in ED patients with possible ACS will be compared to traditional
 testing of this assay for myocardial necrosis obtained in the central laboratory. Our
 hypothesis: point-of-care testing for troponin I will decrease the time for disposition of
 patients with possible ACS in the emergency setting and decrease the time required for
 administering appropriate therapies for these patients.
Cardiac troponin I is routinely used in the emergency department as a risk stratification
 tool for detecting myocardial necrosis in patients with possible acute coronary syndrome. It
 is our hypothesis that having bedside, point-of-care testing for TnI in the ED will decrease
 time needed to disposition patients to home from the ED or send to the cardiac
 catheterization laboratory or intensive care setting. Similarly, having point-of-care testing
 in the ED should decrease the time required to deliver anti-platelet drugs such as aspirin
 and glycoprotein IIb/IIIa inhibitors and anti-thrombin agents such as heparin to high risk
 patients found to have a positive TnI test. This will be evaluated in a randomized,
 controlled clinical trial of 2000 patients. Half will have the test performed in the ED at
 the bedside (point-of-care) while the other half will receive the usual lab results obtained
 from the central lab (typically requiring 1.5-2 hours to return).
Inclusion criteria

 -  Age >21 years old

 -  Chest pain or other symptoms that lead to drawing cardiac bio-markers for possible ACS
 diagnosis

 Exclusion criteria

 -  Presentation with chest pain in the presence of a tachydysrhythmia (ventricular
 tachycardia, supraventricular tachycardia, or rapid atrial fibrillation)

 -  Presentation with ECG diagnostic for STEMI