Objectives Patients with suspected acute coronary syndrome and high-sensitivity cardiac troponin (hs-cTn) concentrations below the limit of detection at presentation are low risk. We aim to determine whether implementing this approach facilitates the safe early discharge of patients. Methods In a prospective single-centre cohort study, consecutive patients with suspected acute coronary syndrome were included before (standard care) and after (intervention) implementation of an early rule-out pathway. During standard care, myocardial infarction was ruled out if hs-cTnT concentrations were <99th centile (14 ng/L) at presentation and at 6–12 hours after symptom onset. In the intervention, patients were ruled out if hs-cTnT concentrations were <5 ng/L at presentation and symptoms present for ≥3 hours or were ≥5 ng/L and unchanged within the reference range at 3 hours. We compared duration of stay (efficacy) and all-cause death at 1 year (safety) before and after implementation. Results We included 10 315 consecutive patients (64±16 years, 46% women) with 6642 (64%) and 3673 (36%) in the standard care and intervention groups, respectively. Duration of stay was reduced from 534 (IQR, 220–2279) to 390 (IQR, 218–1910) min (p<0.001) after implementation. At 1 year, all-cause death occurred in 10.9% (721 of 6642) and 10.4% (381 of 3673) of patients in the standard care group (referent) and intervention group, respectively (adjusted OR 1.02, 95% CI 0.88 to 1.18). Conclusion In patients with suspected acute coronary syndrome, implementing an early rule-out pathway using hs-cTnT concentrations <5 ng/L at presentation reduced the duration of stay in hospital without compromising safety. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information. This study makes use of multiple routine electronic healthcare data sources that are linked, de-identified and held in our safe haven, which are accessible by approved individuals who have undertaken the necessary governance training. All data relevant to the study are included in the manuscript. Summary data can be made available upon request to the corresponding author.

中文翻译：

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使用高灵敏度心肌肌钙蛋白 T 测定实施心肌梗死的早期排除途径

目的 疑似急性冠状动脉综合征且高敏心肌肌钙蛋白 (hs-cTn) 浓度低于就诊时检测限的患者风险较低。我们的目的是确定实施这种方法是否有助于患者安全及早出院。方法 在一项前瞻性单中心队列研究中，连续纳入疑似急性冠状动脉综合征患者在实施早期排除途径之前（标准护理）和之后（干预）。在标准治疗期间，如果就诊时和症状出现后 6-12 小时 hs-cTnT 浓度<99th 百分位数 (14 ng/L)，则可排除心肌梗死。在干预中，如果患者就诊时 hs-cTnT 浓度<5 ng/L且症状出现时间≥3小时，或者≥5 ng/L且3小时后在参考范围内没有变化，则患者被排除。我们比较了实施前后的住院时间（疗效）和 1 年全因死亡（安全性）。结果 我们纳入了 10 315 名连续患者（64±16 岁，46% 女性），标准护理组和干预组分别有 6642 名患者（64%）和 3673 名患者（36%）。实施后，停留时间从 534 分钟（IQR，220-2279）减少到 390 分钟（IQR，218-1910）（p<0.001）。1 年时，标准护理组（参考组）和干预组的患者全因死亡发生率分别为 10.9%（6642 人中的 721 人）和 10.4%（3673 人中的 381 人）（调整后 OR 1.02，95% CI 0.88 1.18）。结论 对于疑似急性冠状动脉综合征患者，使用就诊时 hs-cTnT 浓度 <5 ng/L 实施早期排除途径可缩短住院时间，且不影响安全性。数据可根据合理要求提供。与研究相关的所有数据都包含在文章中或作为补充信息上传。这项研究利用了多个常规电子医疗保健数据源，这些数据源相互关联、去识别化并保存在我们的安全港中，接受过必要治理培训的批准个人可以访问这些数据源。与研究相关的所有数据都包含在手稿中。可以根据相应作者的要求提供摘要数据。