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. 2001 Feb;85(2):143–148. doi: 10.1136/heart.85.2.143

Safe discharge from the cardiac emergency room with a rapid rule-out myocardial infarction protocol using serial CK-MBmass

R Bholasingh 1, R J de Winter 1, J Fischer 1, R Koster 1, R Peters 1, G Sanders 1
PMCID: PMC1729613  PMID: 11156661

Abstract

OBJECTIVE—To determine whether a new protocol, using a rapid and sensitive CK-MBmass assay and serial sampling, can rule out myocardial infarction in patients with chest pain and decrease their length of stay in the cardiac emergency room without increasing risk.
DESIGN—The combined incidence of cardiac death and acute myocardial infarction at 30 days, six months, and 24 months of follow up were compared between patients discharged home from the cardiac emergency room after ruling out myocardial infarction with a CK-MBactivity assay in 1994 and those discharged home after a rapid CK-MBmass assay in 1996.
SETTING—Cardiac emergency room of a large university hospital.
PATIENTS—In 1994 and 1996, 230 and 423 chest pain patients, respectively, were discharged home from the cardiac emergency room with a normal CK-MB and an uneventful observation period.
RESULTS—The median length of stay in the cardiac emergency room was significantly reduced, from 16.0 hours in 1994 to 9.0 hours in 1996 (p < 0.0001). Mean event rates in patients from the 1994 and 1996 cohorts, respectively, were 0.9% (95% confidence interval (CI) −0.3% to 2.1%) v 0.7% (95% CI −0.1% to 1.5%) at 30 days, 3.0% (95% CI 0.8% to 5.2%) v 2.8% (95% CI 1.2% to 4.4%) at six months, and 7.0% (95% CI 3.7% to 10.3%) v 5.7% (95% CI 3.5% to 7.9%) at 24 months. Kaplan-Meier survival analysis showed no difference in mean event-free survival at 30 days, six months, and 24 months of follow up.
CONCLUSIONS—Using a rule-out myocardial infarction protocol with a rapid and sensitive CK-MBmass assay and serial sampling, the length of stay of patients with chest pain in the cardiac emergency room can be reduced without compromising safety.


Keywords: length of stay; cardiac emergency room; creatine kinase-MB; myocardial infarction

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Figure 1  .

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Kaplan-Meier survival curves during a follow up period of 24 months in patients from the 1994 and 1996 cohorts discharged home from the cardiac emergency room after normal CK-MB results and an uneventful observation period. Event-free survival was assessed for cardiac death and non-fatal acute myocardial infarction. Differences were compared by the log-rank test. There was no significant difference in mean event-free survival between the two cohorts (at the 30 days follow up, p = 0.81; at the six months follow up, p = 0.83; at the 24 months follow up, p = 0.56).

Selected References

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