#Tweetorial (1/8)
Is it possible to offer a safe #AMI rule-out for low-risk patients with chest pain outside of hospital EDs?

OUT-ACS study from Norway validates @escardio #ESC 0/1-hour algorithm for hs-cTnT in a primary care emergency setting
http://ow.ly/a4zv30r1zNS 

#Tweetorial (2/8)
Over 2 yrs, approx 12K patients presented to primary care emergency clinic with chest pain
After exam & ECG, 3066 were offered hs-cTnT at prehospital obs unit
Hs-cTnT was sampled at 0, 1 & 4h from 1750 patients
http://ow.ly/CrA330r1zYP 

#Tweetorial (3/8)
By applying #ESC 0/1h algorithm, patients were divided into
• rule-out (n=1311)
• rule-in (n=66)
• observation group (n=320)
Rule-out group had significantly less comorbidity
http://ow.ly/dQHy30r1A0T 

@tonjerj @DrPascalMeier @jhfrudd @yadersandoval

#Tweetorial (4/8)
#AMI was diagnosed in 3.6%

Rule-out group: high safety (76.6%) with NPV 99.9%, sensitivity 98.4% & negative LR of 0.02

Rule-in group: PPV 68.2%, specificity 98.7% & positive LR 58.0

http://ow.ly/32PX30r1A2K 
@chapdoc1 @dan_atar @DrDerekConnolly

#Tweetorial (5/8)
Calculated LRs (likelihood ratios) may aid clinical decision-making process
Post-test probability for #AMI in low-risk setting after #prehospital hs-cTnT sampling is visualised by #Fagan nomogram

http://ow.ly/a4zv30r1zNS 
@DrMarthaGulati @rahatheart1

#Tweetorial (6/8)
90-day incidence of #AMI & all-cause death was low in rule-out group (0.3%), which was obtained through linkage with Norwegian Cardiovascular Disease Registry

http://ow.ly/KjN830r1A6u 
@vass_vassiliou @SukhNijjer @ErinMichos @iamritu @SamRRazaMD

#Tweetorial (7/8)
With high rule-out safety & ability to assign 80.5% of patients to rule-out or rule-in, 0/1-hour algorithm for hs-cTnT seems safe & efficient for a faster assessment of low-risk patients with chest pain in a primary care emergency setting
http://ow.ly/J04v30r1A7p 

#Tweetorial (8/8)
Safe & rapid triage of low-risk patients by #GPs outside of hospital EDs using #ESC 0/1-hour hs-cTnT algorithm may reduce patient crowding in EDs, unnecessary hospitalisations, risk for #overdiagnosis & healthcare expenditure

http://ow.ly/RUr630r1A8z