TY - JOUR
T1 - Improved assessment of chest pain trial (IMPACT)
T2 - Assessing patients with possible acute coronary syndromes
AU - Cullen, Louise
AU - Greenslade, Jaimi H.
AU - Hawkins, Tracey
AU - Hammett, Chris
AU - O’Kane, Shanen
AU - Ryan, Kimberley
AU - Parker, Kate
AU - Schluter, Jessica
AU - Dalton, Emily
AU - Brown, Anthony F.T.
AU - Than, Martin
AU - Peacock, W. Frank
AU - Jaffe, Allan
AU - O’Rourke, Peter K.
AU - Parsonage, William A.
N1 - Funding Information:
Competing interests: Louise Cullen has received grants from Beckman, Roche and Radiometer; grants, consultancy fees, and personal fees from Abbott Diagnostics; grants and consultancy fees from Siemens; and personal fees from Alere, AstraZeneca, and Novartis, all unrelated to this study. Chris Hammett has received personal fees from Astra Zeneca, Amgen, Bayer Healthcare, Boehringer Ingelheim, The Medicines Company and Medtronic, all unrelated to this study. Anthony Brown is a consultant for both Boehringer Ingelheim and Shire, and has been paid to provide expert medical testimony for the Queensland and New South Wales Coronial Services; he receives royalties from Taylor & Francis and Elsevier. Martin Than has received grants, personal fees and other funding from Abbott and Beckman, grants and personal fees from Alere, and personal fees from Roche, all unrelated to this study. Frank Peacock received unrelated grants from Abbott, Alere, Banyan, Cardiorentis, Janssen, Portola, Pfizer, Roche,The Medicines Company, and ZS Pharma; he is a consultant for Alere, Cardiorentis, Ischemia Care, Janssen, Phillips, Portola, Prevencio, The Medicines Company, and ZS Pharma, and has ownership interests in Comprehensive Research Associates and Emergencies in Medicine, all unrelated to this study. Allen Jaffe is a consultant for Abbott, Alere, Siemens, Diadexus, ET Healthcare, Novartis, theheart.org, and Becton Dickinson. William Parsonage is a consultant for Hospira/Pfizer and has received personal fees from AstraZeneca and non-financial support from Bayer, all unrelated to this study.
Publisher Copyright:
© 2017 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved.
PY - 2017/9/4
Y1 - 2017/9/4
N2 - Objective: To examine the safety and efficacy of the Improved Assessment of Chest pain Trial (IMPACT) protocol, a strategy for accelerated assessment of patients presenting to emergency departments (EDs) with chest pain. Design, setting and participants: IMPACT was an intervention trial at a single tertiary referral hospital (Royal Brisbane and Women’s Hospital) during February 2011 e March 2014. 1366 prospectively recruited patients presenting to the ED with symptoms of suspected acute coronary syndrome (ACS) were stratified into groups at low, intermediate or high risk of an ACS. Intervention: High risk patients were treated according to NHFA/CSANZ guidelines. Low and intermediate risk patients underwent troponin testing (sensitive assay) 0 and 2 hours after presentation. Intermediate risk patients underwent objective testing after the second troponin test; low risk patients were discharged without further objective testing. Main outcome measures: The primary outcome was an ACS within 30 days of presentation. Secondary outcomes were ED and hospital lengths of stay (LOS). Results: The IMPACT protocol stratified 244 (17.9%) patients to low risk, 789 (57.7%) to intermediate risk, and 333 (24.4%) to high risk categories. The overall 30-day ACS rate was 6.6%, but there were no ACS events in the low risk group, and 14 (1.8%) in the intermediate risk group. The median hospital LOS was 5.1 hours (IQR, 4.2e5.6 h) for low risk and 7.7 hours (IQR, 6.1e21 h) for intermediate risk patients. Conclusions: The IMPACT protocol safely and efficiently allowed a large proportion of patients presenting to EDs with chest pain to undergo accelerated assessment for risk of an ACS. Clinical trial registration: Australian New Zealand Clinical Trials Registry ACTRN12611000206921.
AB - Objective: To examine the safety and efficacy of the Improved Assessment of Chest pain Trial (IMPACT) protocol, a strategy for accelerated assessment of patients presenting to emergency departments (EDs) with chest pain. Design, setting and participants: IMPACT was an intervention trial at a single tertiary referral hospital (Royal Brisbane and Women’s Hospital) during February 2011 e March 2014. 1366 prospectively recruited patients presenting to the ED with symptoms of suspected acute coronary syndrome (ACS) were stratified into groups at low, intermediate or high risk of an ACS. Intervention: High risk patients were treated according to NHFA/CSANZ guidelines. Low and intermediate risk patients underwent troponin testing (sensitive assay) 0 and 2 hours after presentation. Intermediate risk patients underwent objective testing after the second troponin test; low risk patients were discharged without further objective testing. Main outcome measures: The primary outcome was an ACS within 30 days of presentation. Secondary outcomes were ED and hospital lengths of stay (LOS). Results: The IMPACT protocol stratified 244 (17.9%) patients to low risk, 789 (57.7%) to intermediate risk, and 333 (24.4%) to high risk categories. The overall 30-day ACS rate was 6.6%, but there were no ACS events in the low risk group, and 14 (1.8%) in the intermediate risk group. The median hospital LOS was 5.1 hours (IQR, 4.2e5.6 h) for low risk and 7.7 hours (IQR, 6.1e21 h) for intermediate risk patients. Conclusions: The IMPACT protocol safely and efficiently allowed a large proportion of patients presenting to EDs with chest pain to undergo accelerated assessment for risk of an ACS. Clinical trial registration: Australian New Zealand Clinical Trials Registry ACTRN12611000206921.
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U2 - 10.5694/mja16.01351
DO - 10.5694/mja16.01351
M3 - Article
C2 - 28987132
AN - SCOPUS:85031695113
SN - 0025-729X
VL - 207
SP - 195
EP - 200
JO - Medical Journal of Australia
JF - Medical Journal of Australia
IS - 5
ER -