Affiliations 

  • 1 Department of Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital, Tokyo, Japan. inouelsbm@gmail.com
  • 2 Department of Cardiology, National Heart Centre Singapore and Sengkang General Hospital, Singapore, Singapore
  • 3 Division of Cardiology, Department of Internal Medicine, Taipei City Hospital Yangming Branch, Taipei, Taiwan
  • 4 Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiangmai, Thailand
  • 5 Division of Cardiology, Hospital Al-Sultan Abdullah, University Teknologi MARA, Kuala Lumpur, Malaysia
  • 6 Division of Emergency, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
  • 7 Division of Emergency, Institut Jantung Negara, Kuala Lumpur, Malaysia
  • 8 Departments of Biostatistics, JORTC Data Center, Tokyo, Japan
  • 9 Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
  • 10 Department of Cardiovascular Biology and Medicine, Juntendo Urayasu Hospital, Chiba, Japan
  • 11 Department of Emergency, Teikyo University School of Medicine, Tokyo, Japan
  • 12 Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
  • 13 Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
  • 14 Department of Cardiology, Yokohama Rosai Hospital, Kanagawa, Japan
  • 15 Shimada General Hospital, Chiba, Japan
  • 16 Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
  • 17 Department of Cardiology and University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Hamburg, Germany
  • 18 Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
Trials, 2022 Dec 07;23(1):986.
PMID: 36476401 DOI: 10.1186/s13063-022-06907-4

Abstract

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.