Early Exclusion of Major Adverse Cardiac Events in Emergency Department Chest Pain Patients: prospective observational study
Publication in refereed journal


摘要Study Objectives
The current evaluation of chest pain patients presenting to an emergency department (ED) with suspected acute coronary syndrome (ACS) is a lengthy process involving serial measurements of troponin. We aimed to validate the diagnostic accuracy of combinations of the Thrombolysis in Myocardial Infarction (TIMI) score with a single high-sensitivity cardiac troponin T (hs-cTnT) assay within 2 hours of ED arrival for the early rule-out of 30-day major adverse cardiac events (MACE), and to compare the TIMI score with combinations of heart-type fatty acid binding protein (H-FABP) and a modified HEART score.
602 consecutive adult patients with chest pain (ST-elevation myocardial infarction was excluded) and suspected ACS were recruited with TIMI and HEART scores, and point-of-care H-FABP test performed.
MACE occurred in 42 (7.0%) patients within 30 days. A modified TIMI score of zero alone identified 65 (11%) patients, and a HEART score ≤2 identified 96 (16%) patients, as having low risk for 30-day MACE. No MACE occurred in these groups giving both scores a sensitivity and negative predictive value of 100% (95% CI 91.6-100%), and respectively a specificity of 11.6% (95% CI 9.2-14.5%) and 17.1% (95% CI 14.2-20.5%). Use of both TIMI and HEART scores improved specificity further to 22.0% (95% CI 18.7-25.6%). Early H-FABP had a sensitivity of 41.5% (95% CI 27.8-56.6%) and a specificity of 91.1% (95% CI 88.4-93.2%).
A modified TIMI score of zero or a HEART score of ≤2, incorporating a single hs-cTnT level, will identify patients with low risk of 30-day MACE for early discharge within 2 hours of ED arrival.
著者C.A. Graham, Y.K. Leung, N.M. Cheng, C.P.Y. Chan, A. Lee, J.K.T. Wong, B.P.Y. Yan, A.T. Ahuja, T.H. Rainer
會議名稱16th International Conference of Emergency Medicine
期刊名稱Annals of Emergency Medicine
會議論文集題名16th International Conference of Emergency Medicine
期次4, Supplement
頁次S31 - S32
關鍵詞Early Exclusion; Emergency Department; Chest Pain

上次更新時間 2021-16-09 於 01:23