• Calvin L Kienbacher, Verena Fuhrmann, Raphael van Tulder, Christof Havel, Wolfgang Schreiber, Susanne Rasoul-Rockenschaub, Thomas Wrba, Harald Herkner, Anton N Laggner, and Dominik Roth.
• Department of Emergency Medicine, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
• Int. J. Clin. Pract. 2021 Jun 1; 75 (6): e14133e14133.

ObjectiveEarly diagnosis or rule-out of acute coronary syndrome (ACS) is a key competence of emergency medicine. Changes in the NSTE-ACS guidelines of the European Society of Cardiology (ESC) in 2015 and 2020 both warranted a henceforth more conservative approach regarding high-sensitivity troponin t (hsTnt) testing. We aimed to assess the impact of more conservative guidelines on the frequency of early rule-out and prolonged observation with repeated hsTnt testing at a high-volume tertiary care emergency department.Patients And MethodsWe conducted a pre- and post-changeover analysis 3 months before and 3 months after transition from less (hsTnt cut-off 30 ng/L, 3-hour rule-out) to more conservative (hsTnt cut-off 14 ng/L, 1-hour rule-out) guidelines in 2015, comparing proportions of patients requiring repeated testing.ResultsWe included 5442 cases of symptoms suspicious of acute cardiac origin (3451 before, 1991 after, 2370 (44%) female, age 55 (SD 19) years). The proportion of patients fulfilling early-rule out criteria decreased from 68% (2348 patients) before to 60% (1195 patients) with the 2015 guidelines (P < .01). Those requiring repeated testing significantly (P < .01) increased from 22% (743 patients) to 25% (494 patients). Positive results in repeated testing significantly (P = .02) decreased from 43% (320 patients) to 37% (181 patients). Invasive diagnostics were performed in 91 patients (2.6%) before and in 75 patients (3.8%) after (P = .02) the guideline revision.ConclusionThe implementation of the more conservative 2015 ESC guidelines led to a minor rise in prolonged observations because of an increase in negative repeated testing and to an increase in invasive procedures.© 2021 The Authors. International Journal of Clinical Practice published by John Wiley & Sons Ltd.

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