DIAGNOSTIC ACCURACY OF CT ANGIOGRAPHY VERSUS STRESS ECG: A LARGE RANDOMIZED PROSPECTIVE STUDY OF SUSPECTED ACUTE CORONARY SYNDROME CHEST PAIN IN THE EMERGENCY DEPARTMENT – “CTCOMPARE”

Abstract Background The HEART score is a validated risk stratification tool for chest pain patients presenting to the emergency department and was recently investigated for implementation in a pre-hospital setting. Fingerstick (capillary blood) point-of-care (POC) troponin testing enables quick measurements outside the hospital and seems easier to implement than the current venous blood sampling techniques. This study investigates the diagnostic accuracy of the modified HEART score, integrating fingerstick POC troponin testing, in ruling out acute coronary syndrome (ACS). Methods The data of 96 patients with chest pain, included in a study investigating a novel POC troponin device under development at the cardiac emergency department, were analysed retrospectively. Based on the patients’ admission data and capillary POC high-sensitivity troponin I (hs-cTnI) results, the modified HEART score was determined. The outcome measure, for evaluating the diagnostic accuracy of the modified HEART score, was the occurrence of ACS. Results Of the total study population, 33 patients (34%) were diagnosed with ACS. Seventeen patients (18%) were classified as low risk (0–3 points) and one patient (6%) in this group was diagnosed with ACS. The sensitivity and negative predictive value of the modified HEART score was 97.0 and 97.6%, respectively. Conclusion The modified HEART score, integrating capillary POC hs-cTnI results, is a promising tool for ruling out ACS in patients with chest pain presenting to the cardiac emergency department. These results encourage prospective investigation into the integration of fingerstick POC troponin testing in the modified HEART score in a pre-hospital setting.

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Diagnostic Yield of Emergent Coronary CT Angiography in Intermediate-to-high-risk Patients for Suspected Acute Coronary Syndrome: Results from an Emergency Department Registry

10.1055/s-0038-1641292 ◽

2018 ◽

Author(s):

J Scholtz ◽

D Addison ◽

D Bittner ◽

S Janjua ◽

B Foldyna ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

High Risk ◽

Ct Angiography ◽

Coronary Ct Angiography ◽

Diagnostic Yield ◽

Coronary Syndrome ◽

Coronary Ct ◽

Risk Patients ◽

Emergency Department Registry

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Does Hospital Admission/Observation for Chest Pain Improve Patient Outcomes after Emergency Department Evaluation for Suspected Acute Coronary Syndrome?

Journal of General Internal Medicine ◽

10.1007/s11606-021-06841-2 ◽

2021 ◽

Author(s):

Adam L. Sharp ◽

Aniket A. Kawatkar ◽

Aileen S. Baecker ◽

Rita F. Redberg ◽

Ming-Sum Lee ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Hospital Admission ◽

Patient Outcomes ◽

Coronary Syndrome ◽

Department Evaluation ◽

Improve Patient

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Assessing the Performance of a Novel Point-of-Care Qualitative Assay for Early Diagnosis of Acute Coronary Syndrome

Cardiology ◽

10.1159/000511435 ◽

2020 ◽

pp. 1-8

Author(s):

Ronny Alcalai ◽

Boris Varshisky ◽

Ahmad Marhig ◽

David Leibowitz ◽

Larissa Kogan-Boguslavsky ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Diagnostic Accuracy ◽

Diagnostic Performance ◽

Troponin I ◽

Point Of Care ◽

Final Diagnosis ◽

Cardiac Biomarkers ◽

Fatty Acid Binding ◽

Coronary Syndrome

Background: Early and accurate diagnosis of acute coronary syndrome (ACS) is essential for initiating lifesaving interventions. In this article, the diagnostic performance of a novel point-of-care rapid assay (SensAheart©) is analyzed. This assay qualitatively determines the presence of 2 cardiac biomarkers troponin I and heart-type fatty acid-binding protein that are present soon after onset of myocardial injury. Methods: We conducted a prospective observational study of consecutive patients who presented to the emergency department with typical chest pain. Simultaneous high-sensitive cardiac troponin T (hs-cTnT) and SensAheart testing was performed upon hospital admission. Diagnostic accuracy was computed using SensAheart or hs-cTnT levels versus the final diagnosis defined as positive/negative. Results: Of 225 patients analyzed, a final diagnosis of ACS was established in 138 patients, 87 individuals diagnosed with nonischemic chest pain. In the overall population, as compared to hs-cTnT, the sensitivity of the initial SensAheart assay was significantly higher (80.4 vs. 63.8%, p = 0.002) whereas specificity was lower (78.6 vs. 95.4%, p = 0.036). The overall diagnostic accuracy of SensAheart assay was similar to the hs-cTnT (82.7% compared to 76.0%, p = 0.08). Conclusions: Upon first medical contact, the novel point-of-care rapid SensAheart assay shows a diagnostic performance similar to hs-cTnT. The combination of 2 cardiac biomarkers in the same kit allows for very early detection of myocardial damage. The SensAheart assay is a reliable and practical tool for ruling-in the diagnosis of ACS.

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Abstract 12162: Association of Symptom Clusters With Mode of Transportation to Emergency Department in Patients Diagnosed With Acute Coronary Syndrome

Circulation ◽

10.1161/circ.132.suppl_3.12162 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Leslie L Davis ◽

Thomas P McCoy ◽

Barbara Riegel ◽

Sharon McKinley ◽

Lynn Doering ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Delay Time ◽

Symptom Clusters ◽

Prehospital Delay ◽

Coronary Syndrome ◽

Stress Symptoms ◽

Mode Of Transportation

Background: Prompt treatment of acute coronary syndrome (ACS) has been shown to reduce mortality and morbidity; yet many patients delay seeking care. In order to receive timely care, symptoms of ACS need to be recognized, interpreted, and acted upon. Patients who experience symptoms matching their expectations and those with correct symptom attribution are more likely to use emergency medical services (EMS) as a means of transportation to the hospital. The connection between symptom type and EMS use has not been fully explored. Purpose: To assess if clusters of presenting symptoms are associated with EMS transportation to the emergency department (ED) in patients with ACS and to evaluate if EMS transportation or symptom clusters are associated with prehospital delay time. Methods: A secondary analysis was conducted from the PROMOTION trial, a randomized controlled trial to reduce patient prehospital delay in ACS. Results: Of the 3,522 subjects with coronary artery disease enrolled, 3,087 completed 2-year follow-up. Of these, 331 subjects visited an ED for ACS symptoms during follow-up. Among the 331, 84% (278) had mode of transportation documented; 44% arrived by EMS. Having classic ACS symptoms (chest pain, pressure, or discomfort) in combination with pain symptoms (AOR=2.66, p = 0.011), classic ACS symptoms in combination with stress symptoms (AOR=2.61, p = 0.007) or classic ACS symptoms in combination with both pain and stress symptoms (AOR=3.90, p = 0.012) were associated with higher odds of arriving to the ED by EMS compared to classic ACS symptoms alone. Among 260 patients with prehospital delay time available, arriving by EMS decreased median delay time by 68.5 minutes compared to those with other transportation, after accounting for symptom clusters, patient and study characteristics (p = 0.002). Symptom clusters did not predict delay time in adjusted modeling (p = 0.952). Conclusion: While chest pain was the most prevalent symptom of ACS for most (85%), these findings suggest that it is the cluster of classic ACS symptoms with other types of symptom that motivate patients to use EMS. With less than half of patients using EMS, further research is needed to better understand how symptom clusters influence care-seeking behavior.

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