Early Exclusion of Major Adverse Cardiac Events in Emergency Department Chest Pain Patients: prospective observational study
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AbstractStudy 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.
All Author(s) ListC.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
Name of Conference16th International Conference of Emergency Medicine
Journal nameAnnals of Emergency Medicine
Proceedings Title16th International Conference of Emergency Medicine
Volume Number68
Issue Number4, Supplement
PagesS31 - S32
LanguagesEnglish-United Kingdom
KeywordsEarly Exclusion; Emergency Department; Chest Pain

Last updated on 2020-23-11 at 00:28