RACE-IT - Rapid Acute Coronary Syndrome Exclusion using the Beckman Coulter Access high-sensitivity cardiac troponin I: A stepped-wedge cluster randomized trial

Joseph Miller, Bernard Cook, Gulmohar Singh-Kucukarslan, Amy Tang, Shooshan Danagoulian, Gerard Heath, Ziad Khalifa, Phillip Levy, Simon A Mahler, Nicholas Mills, James McCord, Joseph Miller, Bernard Cook, Gulmohar Singh-Kucukarslan, Amy Tang, Shooshan Danagoulian, Gerard Heath, Ziad Khalifa, Phillip Levy, Simon A Mahler, Nicholas Mills, James McCord

Abstract

Background: Protocols utilizing high-sensitivity cardiac troponin (hs-cTn) assays for the evaluation of suspected acute coronary syndrome (ACS) in the emergency department (ED) have been gaining popularity across the US and the world. These protocols more rapidly rule-out ACS and more accurately identify the presence of acute myocardial injury. At this time, few randomized trials have evaluated the safety and operational impact of these assays, resulting in limited evidence to guide the use and implementation of hs-cTn in the ED.

Objective: The main study objective is to test the effectiveness of a rapid ACS rule-out pathway using hs-cTnI in safely discharging patients from the ED for whom clinical suspicion for ACS exists.

Design: This prospective, implementation trial (n = 11,070) will utilize a stepped wedge cluster randomized trial design. The design will allow for all participating sites to capture benefit from the implementation of the hs-cTnI pathway while providing data evaluating the effectiveness in providing safe and rapid evaluation of patients with clinical suspicion for ACS.

Summary: Demonstrating that clinical pathways using hs-cTnI can be effectively implemented to rapidly rule-out ACS while conserving costly hospital resources has significant implications for the care of patients with possible acute cardiac conditions in EDs across the US.

Clinicaltrialsgov identifier: NCT04488913.

Keywords: Acute coronary syndrome; High sensitivity troponin; Stepped wedge trial.

© 2021 The Authors.

Figures

Fig. 1
Fig. 1
Stepped Implementation Design Matrix. Each segment represents a 3-week period. Blue segments indicate enrollment under the standard of care protocol, and orange cells indicate enrollment under RACE-IT pathway. Green cells indicate 3-week implementation periods for clinician education and time to accommodate practice change, during which patient enrollment does not occur. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

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Source: PubMed

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