IN-HOspital Program to systematizE Chest Pain Protocol (IN-HOPE)

Study Overview
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Brief Summary
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Multicenter Nationwide Study for Analysis of the Potential Impact in Clinical Practice of Early Exclusion Protocols for Acute Myocardial Infarction with High Sensitivity Troponin T

Detailed Description
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Chest pain is the main clinical complaint in emergency room visits and represents the most common symptom of Acute Myocardial Infarction, which is the main cause of death in Brazil and worldwide. Although most patients with chest pain do not have a final diagnosis of AMI, they remain under observation until the diagnosis of AMI is excluded. The most current strategy recommended for rapid AMI exclusion uses high-sensitivity cardiac troponin T at time zero and one hour later. However, some points that have not yet been properly evaluated in previous studies can be evaluated in the current study: Evaluation of the early exclusion protocol (0 -1 hour) in a Brazilian population Evaluation of the early exclusion protocol (0 -1 hour) in isolation and associated with traditional risk scores (TIMI, GRACE, HEART and EDACS) Systematic evaluation of the early exclusion protocol (0 -1 hour) in patients without chest pain but with a pre-defined condition of suspected AMI Evaluation of the prognostic value of an isolated high-sensitivity cardiac troponin T < 5 ng/L in a diverse population.

Official Title
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Potential Impact in Clinical Practice of Early Exclusion Protocols for Acute Myocardial Infarction With High Sensitivity Troponin T in Different Scenarios (IN-HOspital Program to SystematizE Chest Pain Protocol-IN HOPE)

Conditions
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Chest Pain, Acute Coronary Syndrome

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 years of age The patient agrees and signs an informed consent form One of the following 2 criteria: Acute chest pain (last episode of pain beginning <6 hours after inclusion) or Syncope, dyspnea or epigastric pain without an obvious cause at the initial assessment (last episode of one of these symptoms beginning <6 hours after inclusion) associated with at least one of the following factors: Age ≥ 65 years, history of arterial disease, history of diabetes mellitus. Exclusion Criteria: Cardiac arrest or hypoxemia or hemodynamic instability or cardioversion during the first hour of assessment Thrombolytic therapy, primary angioplasty or other medical condition that requires hospitalization identified within one hour after the evaluation Dialysis patients Patients with trauma Myocardial revascularization or acute myocardial infarction in the last month Pregnant and breastfeeding women Patient unable to be followed for 30 days

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Prospective cohort<br>A minimum of 294 patients will be included in the evaluation of 0 and 1 hour protocol (prospective evaluation). | |
| Retrospective cohort<br>A minimum of 1,000 patients will be included in the evaluation of prognostic value of high sensitive cardiac troponin < 5 ng/L(retrospective evaluation). | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Accuracy of early rule out for myocardial infarction diagnosis | Accuracy of the 0 and 1 hour algorithm using troponin for diagnosis of myocardial infarction compared to the gold standard with measurements every 3 hours | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Accuracy of early rule out for myocardial infarction according to type of symptoms | Accuracy of the 0 and 1 hour algorithm using troponin for diagnosis of myocardial infarction compared to the gold standard with measurements every 3 hours with or without chest pain | 30 days | 
| Accuracy of early rule out for myocardial infarction according to chest pain score (TIMI) | Accuracy of the 0 and 1 hour algorithm using troponin for diagnosis of myocardial infarction compared to the gold standard with measurements every 3 hours according to chest pain score (TIMI). TIMI score minimum 0 and maximum 7 points (higher scores mean a worse outcome). | 30 days | 
| Accuracy of early rule out for myocardial infarction according to chest pain score (EDACS) | Accuracy of the 0 and 1 hour algorithm using troponin for diagnosis of myocardial infarction compared to the gold standard with measurements every 3 hours according to chest pain score (EDACS). EDACS score minimum -6 and maximum +20 points (higher scores mean a worse outcome). | 30 days | 
| Accuracy of early rule out for myocardial infarction according to chest pain score (GRACE) | Accuracy of the 0 and 1 hour algorithm using troponin for diagnosis of myocardial infarction compared to the gold standard with measurements every 3 hours according to chest pain score (GRACE). GRACE score minimum 1 and maximum 372 points (higher scores mean a worse outcome). | 30 days | 
| Accuracy of early rule out for myocardial infarction according to chest pain score (HEART) | Accuracy of the 0 and 1 hour algorithm using troponin for diagnosis of myocardial infarction compared to the gold standard with measurements every 3 hours according to chest pain score (HEART). HEART score minimum 0 and maximum 10 points (higher scores mean a worse outcome). | 30 days | 
| Evaluation of the prognostic value (death and myocardial infarction within 30 days) of an isolated high-sensitivity cardiac troponin T < 5 ng/L in a diverse population. | Evaluation of the prognostic value (death and myocardial infarction within 30 days) of an isolated high-sensitivity cardiac troponin T < 5 ng/L in a diverse population (retrospective cohort). | 30 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Chest pain, Acute coronary syndrome, Troponin