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Silvia Valbuena LópezRAPID – TnT
RAPID-TnT – A randmised trial of a 1-hour troponin
T protocol in suspected acute coronary...
Silvia Valbuena LópezRAPID – TnT
BACKGROUND
• Suspected ACS consumes a great part of emergency departments resources
• Hig...
Silvia Valbuena LópezRAPID – TnT
METHODS
• Prospective, randomized, “in practice” non-inferiority evaluation of a 0/1 hour...
Silvia Valbuena LópezRAPID – TnT
STUDY FLOW
Silvia Valbuena LópezRAPID – TnT
METHODS
Silvia Valbuena LópezRAPID – TnT
METHODS
Silvia Valbuena LópezRAPID – TnT
RESULTS. MANAGEMENT RECOMMENDATION
Silvia Valbuena LópezRAPID – TnT
RESULTS. PRIMARY ENDPOINT
Silvia Valbuena LópezRAPID – TnT
RESULTS
Discharged from the ED Time in the ED
o Standard  5.6 h
o 0/1 – Hour  4,6 h
Silvia Valbuena LópezRAPID – TnT
RESULTS. CARDIAC TEST WITHIN 30 DAYS
All patients TnT ≤ 29 ng/l
Silvia Valbuena LópezRAPID – TnT
LIMITATIONS
• Clinical relevance of 0/3 hour vs 0/1 hour protocol
• Still 2 TnT determina...
Silvia Valbuena LópezRAPID – TnT
CONCLUSIONES
• Los pacientes clasificados como “rule-out MI” pueden ser dados de alta de ...
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RAPID TnT Trial

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La Dra. Silvia Valbuena López resume en #SECenESC19 las conclusiones del estudio presentado en ESC Congress 2019.

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RAPID TnT Trial

  1. 1. Silvia Valbuena LópezRAPID – TnT RAPID-TnT – A randmised trial of a 1-hour troponin T protocol in suspected acute coronary síndromes: the Rapid Assessment of Possible ACS In the emergency Department with high sensitivity Troponin T https://doi.org/10.1161/CIRCULATIONAHA.119.042891
  2. 2. Silvia Valbuena LópezRAPID – TnT BACKGROUND • Suspected ACS consumes a great part of emergency departments resources • High sensitivity tropinins have the potential to improve early diagnosis of MI, mainly due to their very high NPV in ruling out MI • However, increased sensitivity could lead to more downstream cardiac testing  uncertain benefit, even harm HYPOTHESIS  compared to standard practice, a clinical care based on a 0/1- hour TnT protocol will provide non-inferior clinical outcomes at 30 days with greater efficiency
  3. 3. Silvia Valbuena LópezRAPID – TnT METHODS • Prospective, randomized, “in practice” non-inferiority evaluation of a 0/1 hour hs-TnT protocol (LoD 5 ng/l), compared to a stantard of care 0/3 hour protocol with masked hs-TnT reporting (only reporting above 29 ng/l) • Conducted in 4 ED in Australia • August 2015-April 2019 • Inclusion criteria  suspected ACS with non-diagnostic ECG for myocardial ischemia • Primary outcome  30 day mortality and MI
  4. 4. Silvia Valbuena LópezRAPID – TnT STUDY FLOW
  5. 5. Silvia Valbuena LópezRAPID – TnT METHODS
  6. 6. Silvia Valbuena LópezRAPID – TnT METHODS
  7. 7. Silvia Valbuena LópezRAPID – TnT RESULTS. MANAGEMENT RECOMMENDATION
  8. 8. Silvia Valbuena LópezRAPID – TnT RESULTS. PRIMARY ENDPOINT
  9. 9. Silvia Valbuena LópezRAPID – TnT RESULTS Discharged from the ED Time in the ED o Standard  5.6 h o 0/1 – Hour  4,6 h
  10. 10. Silvia Valbuena LópezRAPID – TnT RESULTS. CARDIAC TEST WITHIN 30 DAYS All patients TnT ≤ 29 ng/l
  11. 11. Silvia Valbuena LópezRAPID – TnT LIMITATIONS • Clinical relevance of 0/3 hour vs 0/1 hour protocol • Still 2 TnT determination • Recommendations according to protocol but final decision may differ • Increase in coronary angiogram and coronary revascularization
  12. 12. Silvia Valbuena LópezRAPID – TnT CONCLUSIONES • Los pacientes clasificados como “rule-out MI” pueden ser dados de alta de manera segura con una tasa de muerte y reIAM a los 30 días muy baja • Aunque no mejora el diagnóstico, supone una estrategia más eficiente • Todo ello a expensas de una mayor tasa de coronariografía y revascularización. La significación de elevaciones de baja intensidad requerirá más investigación para un manejo adecuado de estos pacientes

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