title: How rapid is rapid? Exemplary results of real-life rapid rule-out troponin timing in troponin-positive acute coronary syndromes without persistent ST-segment elevation in two contrasting German chest pain unit facilities.
abstract: OBJECTIVE
  To analyse the timing of cardiac troponin (cTn) measurements in high-risk and cTn-positive acute coronary syndromes without persistent ST-segment elevation (NSTE-ACS) in two structurally different German chest pain units (CPUs), contrasting an urban university maximum care and a rural regional primary care facility.
  
  
  METHODS
  All patients encoded as NSTEMI during the year 2013 were retrospectively enrolled in two centres: site (I)--centre of maximum care in an urban university setting and site (II)--centre of primary care in a rural regional care setting. Data acquisition included time intervals from admission to baseline cTn and first and second cTn control as well as type and timing of invasive management.
  
  
  RESULTS
  The median times (site I vs. site II) from admission to cTn result announcement were 26.5 vs. 33.0 min (p = 0.02) for baseline, 4 vs. 4 h (p = 0.43) for the first and 11.0 vs. 16.5 h (p = 0.03) for the second control. Timely announcement, as recommended by guidelines, was available in 86.9% at baseline, 59.4% for the first or 41.1% for the second cTn control. Rates and timing of invasive management were independent from the time point of positive cTn announcement (p = 0.51 and p = 0.68, respectively).
  
  
  CONCLUSIONS
  German CPUs provide timely identification of cTn-positive patients in a narrow and guideline-adherent time frame using a rapid rule-out protocol. Especially, baseline and early cTn timing was comparable between the urban university maximum care and the rural regional primary care facility without relevant impact on guideline-conforming invasive management, underlining the high standard of care in those highly professional institutions.
authors.affiliation: Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany. dieter.fischer@ukmuenster.de.
authors.forename: Dieter
authors.initials: D
authors.lastname: Fischer
authors.affiliation: Department of Cardiology, Arnsberg Medical Center, Arnsberg, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Remberg
authors.affiliation: Department of Cardiology, Arnsberg Medical Center, Arnsberg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Böse
authors.affiliation: Department of Angiology, Arnsberg Medical Center, Arnsberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Lichtenberg
authors.affiliation: Department of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kümpers
authors.affiliation: Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany.
authors.forename: Pia
authors.initials: P
authors.lastname: Lebiedz
authors.affiliation: Department of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany.
authors.forename: Hermann-Joseph
authors.initials: HJ
authors.lastname: Pavenstädt
authors.affiliation: Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Waltenberger
authors.affiliation: Department of Cardiology, Arnsberg Medical Center, Arnsberg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Breuckmann
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000378:metabolism*; D002637:Chest Pain; D017023:Coronary Angiography; D005858:Germany; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006757:Hospital Units; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards; D011379:Prognosis; D012189:Retrospective Studies; D012423:Rural Health / Q000592:standards / Q000706:statistics & numerical data; D013997:Time Factors; D020107:Troponin T / Q000032:analysis*; D014504:Urban Health / Q000592:standards / Q000706:statistics & numerical data
chemical_list: D020107:Troponin T
keywords: Cardiac troponin; Chest pain unit; Coronary angiography; NSTEMI; Timing