What is the 30-day rate of adverse cardiac events in chest pain patients with ED troponin I assays≤99th centile using a contemporary sensitive assay? An exploratory analysis

AbstractObjectivesThe new Vancouver Chest Pain (VCP) Rule recommends early discharge for chest pain patients who are at low risk of developing acute coronary syndrome (ACS), and thus can be discharged within 2 hours of arrival at the emergency department (ED). This study aimed to assess the performance of the new VCP Rule for Asian patients presenting with chest pain at the ED.MethodsThis prospective cohort study involved patients attended to at the ED of a large urban centre. Patients of at least 25 years old, presenting with stable chest pain and a non-diagnostic ECG, and with no history of active coronary artery disease were included in the study. The main outcome measures were cardiac events, angioplasty, or coronary artery bypass within 30 days of enrolment.ResultsThe study included 1690 patients from 27 August 2000 to 1 May 2002, with 661 patients fulfilling the VCP criteria. Of those for early discharge, 24 had cardiac events and 13 had angioplasty or bypass at 30 days, compared to 91 and 41, respectively, for those unsuitable for discharge. This gave the rule a sensitivity of 78.1% for cardiac events, including angioplasty and bypass. Specificity was 41.0%, and negative predictive value (NPV) was 94.4%.ConclusionWe found the new VCP Rule to have moderate sensitivity and poor specificity for adverse cardiac events in our population. With an NPV of less than 100%, this means that a small proportion of patients sent home with early discharge would still have adverse cardiac events.

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What is the incidence of major adverse cardiac events in emergency department chest pain patients with a normal ECG, Thrombolysis in Myocardial Infarction score of zero and initial troponin ≤99th centile: an observational study?

Emergency Medicine Journal ◽

10.1136/emermed-2011-200810 ◽

2012 ◽

Vol 30 (1) ◽

pp. 15-18 ◽

Cited By ~ 10

Author(s):

Anne-Maree Kelly

Keyword(s):

Myocardial Infarction ◽

Emergency Department ◽

Chest Pain ◽

Observational Study ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Adverse Cardiac Events ◽

Pain Patients

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External validation of a low HEAR score to identify emergency department chest pain patients at very low risk of major adverse cardiac events without troponin testing

CJEM ◽

10.1007/s43678-021-00159-y ◽

2021 ◽

Author(s):

Connor M. O’Rielly ◽

James E. Andruchow ◽

Andrew D. McRae

Keyword(s):

Emergency Department ◽

Chest Pain ◽

External Validation ◽

Low Risk ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Adverse Cardiac Events ◽

Pain Patients

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Comparing HEART, TIMI, and GRACE scores for prediction of 30-day major adverse cardiac events in high acuity chest pain patients in the emergency department

International Journal of Cardiology ◽

10.1016/j.ijcard.2016.07.147 ◽

2016 ◽

Vol 221 ◽

pp. 759-764 ◽

Cited By ~ 24

Author(s):

Jeffrey Tadashi Sakamoto ◽

Nan Liu ◽

Zhi Xiong Koh ◽

Nicholas Xue Jin Fung ◽

Micah Liam Arthur Heldeweg ◽

...

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Adverse Cardiac Events ◽

High Acuity ◽

Pain Patients

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Abstract 2618: Use of Myeloperoxidase in Chest Pain Evaluation in The Emergency Department

Circulation ◽

10.1161/circ.116.suppl_16.ii_580-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Martin Möckel ◽

Reinhold Müller ◽

Christian Lueders ◽

Janett Reiche ◽

Christian Müller ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Troponin I ◽

Adverse Outcome ◽

Cardiac Events ◽

Coronary Syndrome ◽

Adverse Cardiac Events ◽

Automated Immunoassay ◽

Prognostic Power

Background Elevated levels of myeloperoxidase (MPO) have been reported to indicate adverse outcome in selected patients with chest pain and acute coronary syndrome (ACS) but no data exists on its value in the routine setting of an emergency department (ED). Patients and methods Initial MPO was assessed at admission in 432 consecutive patients presenting to the ED who were evaluated for an acute coronary syndrome. In a subset of 116 patients blood samples were also available after 6 and 12–36 hours. All patients were followed up for six weeks with respect to major adverse cardiac events (MACE) including death, re-admission for heart failure or ACS and unplanned repeat coronary revascularisation. MPO was measured using a fully automated immunoassay in development on the ARCHITECT® platform and its prognostic power was compared with serial cardiac troponin I using cut-offs of 198 pmol/L for MPO and 0.1 μg/L for troponin I. Results Incidence of MACE was 13% in this population. MPO was detectable in all samples with a median of 246.5 (range 18 – 4547) pmol/L at admission. MPO increased significantly after 6h and decreased again after 12–36h. In this low-risk population, initial MPO levels revealed a sensitivity (Sens) of 82.1% and a specificity (Spec) of 37.5% (p<0.0001) for MACE compared with 28.6% Sens and 81.1% Spec (p=0.09 n.s.) for initial troponin I. Sensitivity of both markers improved when available serial information was used (MPO: Sens 96.4, Spec 22.6, p<0.0001; troponin I: Sens 44.6%, Spec 76.1%, p<0.01). In serial troponin I negative patients (n=317), both, initial MPO (Sens 80.6%, Spec 42.7%, p<0.05) and serial MPO (Sens 93.5%, Spec 28.7%, p<0.01) still demonstrated significant discriminatory power. Conclusions MPO has independent prognostic value in unselected patients evaluated for ACS in the ED. However MPO levels vary widely over the first 24h hours and also lack specificity.

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