{"id":619,"date":"2011-04-04T12:25:24","date_gmt":"2011-04-04T11:25:24","guid":{"rendered":"https:\/\/blogs.bmj.com\/heart-journalscan\/?p=619"},"modified":"2015-11-12T15:31:35","modified_gmt":"2015-11-12T14:31:35","slug":"novel-diagnostic-pathway-improves-chest-pain-assessment","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/heart\/2011\/04\/04\/novel-diagnostic-pathway-improves-chest-pain-assessment\/","title":{"rendered":"Novel diagnostic pathway improves chest pain assessment"},"content":{"rendered":"

Although 75-85% of patients presenting to the emergency department with chest pain ultimately do not receive a diagnosis of acute coronary syndrome, a lengthy assessment process is still mandatory as patients with a missed diagnosis of myocardial infarction are at increased risk for a cardiovascular event. \u00a0Than et al. prospectively validated the safety of a predefined accelerated diagnostic protocol (ADP)\u00a0aimed at assessing chest pain patients within two hours.<\/p>\n

The study took place in 14 emergency departments across the Asia-Pacific region. \u00a0The ADP developed utilised a structured pre-test probability scoring method including Thrombolysis in Myocardial Infarction [TIMI] score, electrocardiography, and point-of-care biomarker panel of troponin, creatine kinase MB, and myoglobin. The primary endpoint was major adverse cardiac events within 30 days after initial presentation (including initial hospital attendance).<\/p>\n

During the course of the study 3582 consecutive patients were recruited and completed follow-up, of which 421 (11\u00b78%) patients had a major adverse cardiac event (see breakdown in figure). The ADP classified 352 (9\u00b78%) of all patients as low risk and potentially suitable for early discharge. A major adverse cardiac event occurred in only three (0\u00b79%) of these patients, giving the ADP a sensitivity of 99\u00b73% (95% CI 97\u00b79\u201399\u00b78), a negative predictive value of 99\u00b71% (97\u00b73\u201399\u00b78), and a specificity of 11\u00b70% (10\u00b70\u201312\u00b72).<\/p>\n

Conclusions:<\/strong><\/p>\n

A novel accelerated diagnostic protocol can be used to identify emergency department patients who are at low-risk of cardiovascular events in the short term. \u00a0Although longer-term follow-up is needed, this protocol may allow a more efficient assessment of chest pain in the emergency department.<\/p>\n