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There are, however, little data on the performance of this strategy when combined with clinical risk stratification. We aimed to evaluate the diagnostic accuracy of an accelerated diagnostic protocol (ADP<\/jats:styled-content>) using the 0\u2010hour\/1\u2010hour hs\u2010cTnT<\/jats:styled-content> strategy together with an adapted Thrombolysis In Myocardial Infarction (TIMI<\/jats:styled-content>) score and electrocardiogram (ECG<\/jats:styled-content>) for ruling out major adverse cardiac events (MACE<\/jats:styled-content>) within 30 days.<\/jats:p><\/jats:sec>Methods<\/jats:title>This prospective observational study enrolled consecutive emergency department (ED<\/jats:styled-content>) chest pain patients. TIMI<\/jats:styled-content> score variables, ED<\/jats:styled-content> physicians\u2019 assessments of the ECG<\/jats:styled-content>, and 0\u2010 and 1\u2010hour hs\u2010cTnT<\/jats:styled-content> were collected. Thirty\u2010day MACE<\/jats:styled-content> was defined as acute myocardial infarction (AMI<\/jats:styled-content>), unstable angina (UA<\/jats:styled-content>), cardiogenic shock, ventricular arrhythmia, atrioventricular block, cardiac arrest, or death of cardiac or unknown cause.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 1,020 patients were included in the final analysis. The combination of an adapted TIMI<\/jats:styled-content> score \u22641, a nonischemic ECG<\/jats:styled-content>, and either a 0\u2010hour hs\u2010cTnT<\/jats:styled-content>\u00a0<\u00a05 ng\/L or a 0\u2010hour hs\u2010cTnT<\/jats:styled-content>\u00a0<\u00a012 ng\/L combined with a 1\u2010hour increase\u00a0<\u00a03 ng\/L identified 432 (42.4%) patients as very low risk with a negative predictive value of 99.5% (95% confidence interval [CI<\/jats:styled-content>]\u00a0= 98.3%\u201399.9%) and a negative likelihood ratio of 0.04 (95% CI<\/jats:styled-content>\u00a0= 0.01\u20130.14) for 30\u2010day MACE<\/jats:styled-content>. The ADP<\/jats:styled-content> missed only two patients with UA<\/jats:styled-content> and no patients with AMI<\/jats:styled-content> or other forms of MACE.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>An ADP<\/jats:styled-content> using the guideline recommended 0\u2010hour\/1\u2010hour hs\u2010cTnT<\/jats:styled-content> strategy rapidly identified patients with a very low risk of 30\u2010day MACE<\/jats:styled-content> including UA<\/jats:styled-content> where no further cardiac testing would be needed. This could potentially allow safe early discharge of about 40% of ED<\/jats:styled-content> chest pain patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13224","type":"journal-article","created":{"date-parts":[[2017,5,13]],"date-time":"2017-05-13T09:07:49Z","timestamp":1494666469000},"page":"983-992","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["A 0\u2010Hour\/1\u2010Hour Protocol for Safe, Early Discharge of Chest Pain Patients"],"prefix":"10.1111","volume":"24","author":[{"given":"Arash","family":"Mokhtari","sequence":"first","affiliation":[{"name":"Department of Internal and Emergency Medicine Sk\u00e5ne University Hospital Lund"},{"name":"Department of Cardiology Lund University Sk\u00e5ne University Hospital Lund"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bertil","family":"Lindahl","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Uppsala Clinical Research Center Uppsala University Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandru","family":"Schiopu","sequence":"additional","affiliation":[{"name":"Department of Cardiology Lund University Sk\u00e5ne University Hospital Lund"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Troels","family":"Yndigegn","sequence":"additional","affiliation":[{"name":"Department of Cardiology Lund University Sk\u00e5ne University Hospital Lund"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ardavan","family":"Khoshnood","sequence":"additional","affiliation":[{"name":"Department of Internal and Emergency Medicine Sk\u00e5ne University Hospital Lund"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrik","family":"Gilje","sequence":"additional","affiliation":[{"name":"Department of Cardiology Lund University Sk\u00e5ne University Hospital Lund"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulf","family":"Ekelund","sequence":"additional","affiliation":[{"name":"Department of Internal and Emergency Medicine Sk\u00e5ne University Hospital Lund"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,7,26]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"1","article-title":"National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary","volume":"2008","author":"Pitts SR","year":"2006","journal-title":"Natl Health Stat Report"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja14.00472"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2012.940"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.01.059"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2016.06.008"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0900428"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2012.3698"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv320"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13012"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2015.11.013"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.022677"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.06.049"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h15"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.024687"},{"key":"e_1_2_8_16_1","unstructured":"Chest Pain of Recent Onset: Assessment and Diagnosis of Recent Onset Chest Pain or Discomfort of Suspected Cardiac Origin (Update). 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