An international, stepped wedge, cluster-randomized trial investigating the 0/1-h algorithm in suspected acute coronary syndrome in Asia: the rational of the DROP-Asian ACS study
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An international, stepped wedge, cluster-randomized trial investigating the 0/1-h algorithm in suspected acute coronary syndrome in Asia: the rational of the DROP-Asian ACS study. / Inoue, Kenji; Chieh, Jack Tan Wei; Yeh, Lim Chiw; Chiang, Shuo-Ju; Phrommintikul, Arintaya; Suwanasom, Pannipa; Kasim, Sazzli; Ahmad, Bakhtiar; Idrose, Alzamani Mohammad; Salleh, Farina Mohd; Oyamada, Shunsuke; Hirano, Yohei; Ouchi, Shohei; Terakura, Moriyuki; Yokoyama, Naoyuki; Kozuma, Ken; Nanasato, Mamoru; Higuchi, Ryosuke; Yumoto, Kazuhiko; Fukuzawa, Tomoyuki; Shimada, Issei; Giannitsis, Evangelos; Twerenbold, Raphael; Minamino, Tohru.
in: TRIALS, Jahrgang 23, Nr. 1, 07.12.2022, S. 986.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - An international, stepped wedge, cluster-randomized trial investigating the 0/1-h algorithm in suspected acute coronary syndrome in Asia: the rational of the DROP-Asian ACS study
AU - Inoue, Kenji
AU - Chieh, Jack Tan Wei
AU - Yeh, Lim Chiw
AU - Chiang, Shuo-Ju
AU - Phrommintikul, Arintaya
AU - Suwanasom, Pannipa
AU - Kasim, Sazzli
AU - Ahmad, Bakhtiar
AU - Idrose, Alzamani Mohammad
AU - Salleh, Farina Mohd
AU - Oyamada, Shunsuke
AU - Hirano, Yohei
AU - Ouchi, Shohei
AU - Terakura, Moriyuki
AU - Yokoyama, Naoyuki
AU - Kozuma, Ken
AU - Nanasato, Mamoru
AU - Higuchi, Ryosuke
AU - Yumoto, Kazuhiko
AU - Fukuzawa, Tomoyuki
AU - Shimada, Issei
AU - Giannitsis, Evangelos
AU - Twerenbold, Raphael
AU - Minamino, Tohru
N1 - © 2022. The Author(s).
PY - 2022/12/7
Y1 - 2022/12/7
N2 - BACKGROUND: More than half of the world's population lives in Asia. With current life expectancies in Asian countries, the burden of cardiovascular disease is increasing exponentially. Overcrowding in the emergency departments (ED) has become a public health problem. Since 2015, the European Society of Cardiology recommends the use of a 0/1-h algorithm based on high-sensitivity cardiac troponin (hs-cTn) for rapid triage of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). However, these algorithms are currently not recommended by Asian guidelines due to the lack of suitable data.METHODS: The DROP-Asian ACS is a prospective, stepped wedge, cluster-randomized trial enrolling 4260 participants presenting with chest pain to the ED of 12 acute care hospitals in five Asian countries (UMIN; 000042461). Consecutive patients presenting with suspected acute coronary syndrome between July 2022 and Apr 2024 were included. Initially, all clusters will apply "usual care" according to local standard operating procedures including hs-cTnT but not the 0/1-h algorithm. The primary outcome is the incidence of major adverse cardiac events (MACE), the composite of all-cause death, myocardial infarction, unstable angina, or unplanned revascularization within 30 days. The difference in MACE (with one-sided 95% CI) was estimated to evaluate non-inferiority. The non-inferiority margin was prespecified at 1.5%. Secondary efficacy outcomes include costs for healthcare resources and duration of stay in ED.CONCLUSIONS: This study provides important evidence concerning the safety and efficacy of the 0/1-h algorithm in Asian countries and may help to reduce congestion of the ED as well as medical costs.
AB - BACKGROUND: More than half of the world's population lives in Asia. With current life expectancies in Asian countries, the burden of cardiovascular disease is increasing exponentially. Overcrowding in the emergency departments (ED) has become a public health problem. Since 2015, the European Society of Cardiology recommends the use of a 0/1-h algorithm based on high-sensitivity cardiac troponin (hs-cTn) for rapid triage of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). However, these algorithms are currently not recommended by Asian guidelines due to the lack of suitable data.METHODS: The DROP-Asian ACS is a prospective, stepped wedge, cluster-randomized trial enrolling 4260 participants presenting with chest pain to the ED of 12 acute care hospitals in five Asian countries (UMIN; 000042461). Consecutive patients presenting with suspected acute coronary syndrome between July 2022 and Apr 2024 were included. Initially, all clusters will apply "usual care" according to local standard operating procedures including hs-cTnT but not the 0/1-h algorithm. The primary outcome is the incidence of major adverse cardiac events (MACE), the composite of all-cause death, myocardial infarction, unstable angina, or unplanned revascularization within 30 days. The difference in MACE (with one-sided 95% CI) was estimated to evaluate non-inferiority. The non-inferiority margin was prespecified at 1.5%. Secondary efficacy outcomes include costs for healthcare resources and duration of stay in ED.CONCLUSIONS: This study provides important evidence concerning the safety and efficacy of the 0/1-h algorithm in Asian countries and may help to reduce congestion of the ED as well as medical costs.
KW - Humans
KW - Acute Coronary Syndrome/diagnosis
KW - Prospective Studies
KW - Asia/epidemiology
U2 - 10.1186/s13063-022-06907-4
DO - 10.1186/s13063-022-06907-4
M3 - SCORING: Journal article
C2 - 36476401
VL - 23
SP - 986
JO - TRIALS
JF - TRIALS
SN - 1745-6215
IS - 1
ER -