Prospective external validation of an accelerated (2-h) acute coronary syndrome rule-out process using a contemporary troponin assay

Kelly, Anne-Maree & Klim, Sharon (2014) Prospective external validation of an accelerated (2-h) acute coronary syndrome rule-out process using a contemporary troponin assay. International Journal of Emergency Medicine, 7, pp. 1-5.

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Background: Recently there have been efforts to derive safe, efficient processes to rule out acute coronary syndrome (ACS) in emergency department (ED) chest pain patients. We aimed to prospectively validate an ACS assessment pathway (the 2-Hour Accelerated Diagnostic Protocol to Assess Patients with Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) pathway) under pragmatic ED working conditions.

Methods: This prospective cohort study included patients with atraumatic chest pain in whom ACS was suspected but who did not have clear evidence of ischaemia on ECG. Thrombolysis in myocardial infarction (TIMI) score and troponin (TnI Ultra) were measured at ED presentation, 2 h later and according to current national recommendations. The primary outcome of interest was the occurrence of major adverse cardiac events (MACE) including prevalent myocardial infarction (MI) at 30 days in the group who had a TIMI score of 0 and had presentation and 2-h TnI assays <99th percentile.

Results: Eight hundred and forty patients were studied of whom 177 (21%) had a TIMI score of 0. There were no MI, MACE or revascularization in the per protocol and intention-to-treat 2-h troponin groups (0%, 95% confidence interval (CI) 0% to 4.5% and 0%, 95% CI 0% to 3.8%, respectively). The negative predictive value (NPV) was 100% (95% CI 95.5% to 100%) and 100% (95% CI 96.2% to 100%), respectively.

Conclusions: A 2-h accelerated rule-out process for ED chest pain patients using electrocardiography, a TIMI score of 0 and a contemporary sensitive troponin assay accurately identifies a group at very low risk of 30-day MI or MACE.

Impact and interest:

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ID Code: 88490
Item Type: Journal Article
Refereed: Yes
Keywords: Chest pain; Troponin; Acute coronary syndrome
DOI: 10.1186/s12245-014-0042-3
ISSN: 1865-1380
Divisions: Past > Research Centres > Centre for Health Research
Current > QUT Faculties and Divisions > Faculty of Health
Copyright Owner: Copyright 2014 Kelly and Klim; licensee Springer.
Deposited On: 21 Oct 2015 06:43
Last Modified: 25 Jun 2017 19:03

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