Grant: Project Grant

Prior clinical studies and new European guidelines have proposed that patients coming to the emergency room (ER) with chest pain can be either sent home or admitted based on one blood test (hs-cTn) result. However, we believe that this guideline will miss patients that need to have treatment and possibly admit patients that may not need treatment. We have published data indicating that the combination of hs-cTn and glucose (i.e., sugar in the blood) is better than hs-cTn alone in identifying patients who can be sent home or admitted in our previously funded CIHR study. We have followed this work up by deriving different laboratory scores that combines important information regarding heart function, kidney function, and sugar status together with hs-cTn to identify which patients can be sent home immediately from the ER and which patients need to stay in the hospital. Our new study is to determine if our findings can be extended to identify those patients that are heart healthy and sick up to 2 years after their initial ER visit in 3 different populations. The first population would be those patients who are being investigated for a heart attack in the ER and who have enrolled in our previous CIHR study. The second population would be all patients that have clinically cardiac troponin ordered, with hs-cTn measured for research purposes, in the ER in one city. The third population will be all ER patients in the province of Ontario who have hs-cTn reported. We will investigate if hs-cTn alone and interpreted with the European guidelines is better than our laboratory scores at ER presentation for predicting which patients will or will not suffer from a heart attack, or heart failure, or will die at 30-days, 1, 2-years after their visit. The findings from our study will determine the best pathway forward for using hs-cTn at ER presentation and will be a significant step towards safely discharging and admitting patients to the hospital based on a single blood draw.