Physical fitness cannot be used to predict the likelihood of acute coronary syndromes in ED patients with chest pain

IntroductionWithin the UK, chest pain is one of the most common reasons for emergency (999) ambulance calls and the most common reason for emergency hospital admission. Diagnosing acute coronary syndromes (ACS) in a patient with chest pain in the prehospital setting by a paramedic is challenging. The Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision rule is a validated tool used in the emergency department (ED) to stratify patients with suspected ACS following a single blood test.We are seeking to evaluate the diagnostic accuracy of the T-MACS decision aid algorithm to ‘rule out’ ACS when used in the prehospital environment with point-of-care troponin assays. If successful, this could allow paramedics to immediately rule out ACS for patients in the ‘very low risk’ group and avoid the need for transport to the ED, while also risk stratifying other patients using a single blood sample taken in the prehospital setting.Methods and analysisWe will recruit patients who call emergency (999) ambulance services where the responding paramedic suspects cardiac chest pain. The data required to apply T-MACS will be prospectively recorded by paramedics who are responding to each patient. Paramedics will be required to draw a venous blood sample at the time of arrival to the patient. Blood samples will later be tested in batches for cardiac troponin, using commercially available troponin assays. The primary outcome will be a diagnosis of acute myocardial infarction, established at the time of initial hospital admission. The secondary outcomes will include any major adverse cardiac events within 30 days of enrolment.Ethics and disseminationThe study obtained approval from the National Research Ethics Service (reference: 18/ES/0101) and the Health Research Authority. We will publish our findings in a high impact general medical journal.Trial registration numberRegistration number: ClinicalTrials.gov, study ID: NCT03561051

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Improved Assessment of Chest pain Trial (IMPACT): assessing patients with possible acute coronary syndromes

The Medical Journal of Australia ◽

10.5694/mja16.01351 ◽

2017 ◽

Vol 207 (5) ◽

pp. 195-200 ◽

Cited By ~ 17

Author(s):

Louise Cullen ◽

Jaimi H Greenslade ◽

Tracey Hawkins ◽

Chris Hammett ◽

Shanen O'Kane ◽

...

Keyword(s):

Chest Pain ◽

Acute Coronary Syndromes ◽

Coronary Syndromes

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High-Risk Plaque Detected on Coronary CT Angiography Predicts Acute Coronary Syndromes Independent of Significant Stenosis in Acute Chest Pain: Results from the Romicat-II Trial

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2014.11.013 ◽

2015 ◽

Vol 48 (1) ◽

pp. 130

Author(s):

Stephanie Oberfoell

Keyword(s):

Chest Pain ◽

High Risk ◽

Ct Angiography ◽

Acute Coronary Syndromes ◽

Coronary Ct Angiography ◽

Acute Chest Pain ◽

Significant Stenosis ◽

Coronary Ct ◽

Coronary Syndromes

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Chest Pain and Acute Coronary Syndromes (ACS)

Essentials of Emergency Medicine ◽

10.5005/jp/books/10275_10 ◽

2003 ◽

pp. 43-43

Author(s):

Shashiraj E ◽

Babu Palatty ◽

Amiya Chakraborty

Keyword(s):

Chest Pain ◽

Acute Coronary Syndromes ◽

Coronary Syndromes

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Coronavirus disease 2019 is delaying the diagnosis and management of chest pain, acute coronary syndromes, myocarditis and heart failure

Future Cardiology ◽

10.2217/fca-2020-0088 ◽

2021 ◽

Vol 17 (1) ◽

pp. 3-6 ◽

Cited By ~ 1

Author(s):

Bhurint Siripanthong ◽

Thomas C Hanff ◽

Michael G Levin ◽

Mahesh K Vidula ◽

Mohammed Y Khanji ◽

...

Keyword(s):

Heart Failure ◽

Chest Pain ◽

Acute Coronary Syndromes ◽

Diagnosis And Management ◽

Coronary Syndromes

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Chest pain and chest pain units

10.1093/med/9780199687039.003.0008_update_001 ◽

2018 ◽

Author(s):

Eric Durand ◽

Aurès Chaib ◽

Etienne Puymirat ◽

Nicolas Danchin

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Acute Coronary Syndromes ◽

Acute Chest Pain ◽

The United States ◽

Cardiac Biomarkers ◽

Coronary Syndrome ◽

Cardiology Department ◽

Coronary Syndromes ◽

Rule Out

Patients presenting at the emergency department with acute chest pain and suspected to represent an acute coronary syndrome were classically admitted as routine to the cardiology department, resulting in expensive and time-consuming evaluations. However, 2-5% of patients with acute coronary syndromes were discharged home inappropriately, resulting in increased mortality. To address the inability to exclude the diagnosis of acute coronary syndrome, chest pain units were developed, particularly in the United States. These provide an environment where serial electrocardiograms, cardiac biomarkers, and provocative testing can be performed to confirm or rule out an acute coronary syndrome. Eligible candidates include the majority of patients with non-diagnostic electrocardiograms. The results have been impressive; chest pain units have markedly reduced adverse events, while simultaneously increasing the rate of safe discharge by 36%. Despite evidence to suggest that care in chest pain units is more effective for such patients, the percentage of emergency or cardiology departments setting up chest pain units remains low in Europe.

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