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Article: Early Exclusion of Major Adverse Cardiac Events in Emergency Department Chest Pain Patients: A Prospective Observational Study

TitleEarly Exclusion of Major Adverse Cardiac Events in Emergency Department Chest Pain Patients: A Prospective Observational Study
Authors
Keywordsdiagnosis
acute coronary syndrome
major adverse cardiac event
chest pain
Issue Date2017
Citation
Journal of Emergency Medicine, 2017, v. 53, n. 3, p. 287-294 How to Cite?
Abstract© 2017 Elsevier Inc. Background The current evaluation of patients with chest pain presenting to an emergency department (ED) with suspected acute coronary syndrome (ACS) is a lengthy process involving serial measurements of troponin. Objective We aimed to validate the diagnostic accuracy of a Thrombolysis in Myocardial Infarction (TIMI) score with single high-sensitive cardiac troponin T (hs-cTnT) for 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 (history, electrocardiogram, age, risk factors, troponin) score. Methods We recruited 602 consecutive adult patients with chest pain and suspected ACS in the ED. Each patient had TIMI and HEART scores, and a point-of-care H-FABP test. Results MACE occurred in 42 (7.0%) patients within 30 days. A low risk for 30-day MACE was identified by a modified TIMI score of 0 in 65 (11%) patients, and by a HEART score ≤ 2 in 96 (16%) patients. No MACE occurred in these groups, giving both scores a sensitivity of 100% (95% confidence interval [CI] 91.6–100%), and specificity of 11.6% (95% CI 9.2–14.5%) and 17.1% (95% CI 14.2–20.5%), respectively. Use of combined TIMI and HEART scores improved the specificity further to 22.0% (95% CI 18.7–25.6%) without lowering sensitivity. Early H-FABP measurement > 7 μg/L had a sensitivity of 41.5% (95% CI 27.8–56.6%) and a specificity of 91.1% (95% CI 88.4–93.2%) for predicting 30-day MACE. Conclusions A modified TIMI score of 0 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 h of ED arrival.
Persistent Identifierhttp://hdl.handle.net/10722/293043
ISSN
2023 Impact Factor: 1.2
2023 SCImago Journal Rankings: 0.433
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLeung, Yuk ki-
dc.contributor.authorCheng, Nga man-
dc.contributor.authorChan, Cangel Pui yee-
dc.contributor.authorLee, Anna-
dc.contributor.authorWong, Jeffrey Ka tak-
dc.contributor.authorYan, Bryan Ping yen-
dc.contributor.authorAhuja, Anil Tejbhan-
dc.contributor.authorGraham, Colin Alexander-
dc.contributor.authorRainer, Timothy Hudson-
dc.date.accessioned2020-11-17T14:57:45Z-
dc.date.available2020-11-17T14:57:45Z-
dc.date.issued2017-
dc.identifier.citationJournal of Emergency Medicine, 2017, v. 53, n. 3, p. 287-294-
dc.identifier.issn0736-4679-
dc.identifier.urihttp://hdl.handle.net/10722/293043-
dc.description.abstract© 2017 Elsevier Inc. Background The current evaluation of patients with chest pain presenting to an emergency department (ED) with suspected acute coronary syndrome (ACS) is a lengthy process involving serial measurements of troponin. Objective We aimed to validate the diagnostic accuracy of a Thrombolysis in Myocardial Infarction (TIMI) score with single high-sensitive cardiac troponin T (hs-cTnT) for 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 (history, electrocardiogram, age, risk factors, troponin) score. Methods We recruited 602 consecutive adult patients with chest pain and suspected ACS in the ED. Each patient had TIMI and HEART scores, and a point-of-care H-FABP test. Results MACE occurred in 42 (7.0%) patients within 30 days. A low risk for 30-day MACE was identified by a modified TIMI score of 0 in 65 (11%) patients, and by a HEART score ≤ 2 in 96 (16%) patients. No MACE occurred in these groups, giving both scores a sensitivity of 100% (95% confidence interval [CI] 91.6–100%), and specificity of 11.6% (95% CI 9.2–14.5%) and 17.1% (95% CI 14.2–20.5%), respectively. Use of combined TIMI and HEART scores improved the specificity further to 22.0% (95% CI 18.7–25.6%) without lowering sensitivity. Early H-FABP measurement > 7 μg/L had a sensitivity of 41.5% (95% CI 27.8–56.6%) and a specificity of 91.1% (95% CI 88.4–93.2%) for predicting 30-day MACE. Conclusions A modified TIMI score of 0 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 h of ED arrival.-
dc.languageeng-
dc.relation.ispartofJournal of Emergency Medicine-
dc.subjectdiagnosis-
dc.subjectacute coronary syndrome-
dc.subjectmajor adverse cardiac event-
dc.subjectchest pain-
dc.titleEarly Exclusion of Major Adverse Cardiac Events in Emergency Department Chest Pain Patients: A Prospective Observational Study-
dc.typeArticle-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.jemermed.2017.05.006-
dc.identifier.pmid28992867-
dc.identifier.scopuseid_2-s2.0-85030660884-
dc.identifier.volume53-
dc.identifier.issue3-
dc.identifier.spage287-
dc.identifier.epage294-
dc.identifier.isiWOS:000414705500006-
dc.identifier.issnl0736-4679-

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