The feasibility and diagnostic accuracy by multiple cardiac biomarkers in emergency chest pain patients: a clinical analysis to compare 290 suspected acute coronary syndrome cases stratified by age and gender in Taiwan

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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Reliability of the CARE rule and the HEART score to rule out an acute coronary syndrome in non-traumatic chest pain patients

Internal and Emergency Medicine ◽

10.1007/s11739-018-1803-4 ◽

2018 ◽

Vol 13 (7) ◽

pp. 1111-1119 ◽

Cited By ~ 3

Author(s):

Thomas Moumneh ◽

Vanessa Richard-Jourjon ◽

Emilie Friou ◽

Fabrice Prunier ◽

Caroline Soulie-Chavignon ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Heart Score ◽

Coronary Syndrome ◽

Pain Patients ◽

Rule Out

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PP23 Accuracy of emergency medical services (EMS) telephone triage in identifying acute coronary syndrome (ACS) for chest pain patients. A systematic review abstract

Emergency Medicine Journal ◽

10.1136/emermed-2021-999.23 ◽

2021 ◽

Vol 38 (9) ◽

pp. A10.2-A10

Author(s):

Ahmed Alotaibi ◽

Abdulrhman Alghamdi ◽

Charles Reynard ◽

Richard Body

Keyword(s):

Systematic Review ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Prediction Models ◽

Meta Analysis ◽

Final Diagnosis ◽

Telephone Triage ◽

Coronary Syndrome ◽

Life Threatening ◽

Pain Patients

IntroductionChest pain is one of the most common reasons for ambulance callouts and presentation to Emergency Departments (EDs). Differentiating patients with serious conditions (e.g. acute coronary syndrome [ACS]) from the majority, who have self-limiting, non-cardiac conditions is extremely challenging. This causes over-triage and over-use of healthcare resources. We aimed to systematically review existing evidence on the accuracy of emergency telephone triage to detect ACS or life-threatening conditions associated with chest pain.MethodsWe conducted a systematic review in accordance with PRISMA guidelines. Two independent investigators searched the Embase, Medline, and Cinahl databases for relevant papers. We included retrospective and prospective cohort studies written in English and investigating EMS telephone triage for chest pain patients linked with final diagnosis of ACS. Studies were summarised in a narrative format as the data were not suitable for meta-analysis.ResultIn total, 553 studies were identified from the literature search and cross-referencing. After excluding 550 studies, three were eligible for inclusion. Among those 3 studies, there are different prediction models developed by authors with variation in variables to detect ACS. The result showed that dispatch triage tools have good sensitivity to detect ACS and life-threatening conditions although they are used to triage sign and symptoms rather than diagnosing the patients. On the other hand, prediction models were built to detect ACS and life-threatening conditions and therefore it showed better sensitivity and NPV.ConclusionEMS dispatch systems accuracy for ACS and life-threatening conditions associated with chest pain is good. Since the dispatch tools were built to triage ambulance response priority based on sign and symptoms, this led to over triage among non-life-threatening chest pain patients. Over triage were slightly reduced by deriving prediction models and showed better sensitivity.

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Novel Emergency Department Risk Score Discriminates Acute Coronary Syndrome Among Chest Pain Patients With Known Coronary Artery Disease

Critical Pathways in Cardiology ◽

10.1097/hpc.0000000000000091 ◽

2016 ◽

Vol 15 (4) ◽

pp. 138-144 ◽

Cited By ~ 1

Author(s):

Matthew T. Crim ◽

Scott A. Berkowitz ◽

Mustapha Saheed ◽

Jason Miller ◽

Amy Deutschendorf ◽

...

Keyword(s):

Coronary Artery Disease ◽

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Coronary Artery ◽

Risk Score ◽

Coronary Syndrome ◽

Artery Disease ◽

Pain Patients

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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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External validation of an emergency department triage algorithm for chest pain patients

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620903452 ◽

2020 ◽

Vol 9 (6) ◽

pp. 576-585

Author(s):

Òscar Miró ◽

Pedro Lopez-Ayala ◽

Gemma Martínez-Nadal ◽

Valentina Troester ◽

Ivo Strebel ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Low Risk ◽

Single Centre ◽

Coronary Syndrome ◽

Emergency Department Triage ◽

Model C ◽

Triage Algorithm ◽

Pain Patients

Background We aimed to externally validate an emergency department triage algorithm including five hierarchical clinical variables developed to identify chest pain patients at low risk of having an acute coronary syndrome justifying delayed rather than immediate evaluation. Methods In a single-centre cohort enrolling 29,269 consecutive patients presenting with chest pain, the performance of the algorithm was compared against the emergency department discharge diagnosis. In an international multicentre study enrolling 4069 patients, central adjudication by two independent cardiologists using all data derived from cardiac work-up including follow-up served as the reference. Triage towards ‘low-risk’ required absence of all five clinical ‘high-risk’ variables: history of coronary artery disease, diabetes, pressure-like chest pain, retrosternal chest pain and age above 40 years. Safety (sensitivity and negative predictive value (NPV)) and efficacy (percentage of patients classified as low risk) was tested in this initial proposal (Model A) and in two additional models: omitting age criteria (Model B) and allowing up to one (any) of the five high-risk variables (Model C). Results The prevalence of acute coronary syndrome was 9.4% in the single-centre and 28.4% in the multicentre study. The triage algorithm had very high sensitivity/NPV in both cohorts (99.4%/99.1% and 99.9%/99.1%, respectively), but very low efficacy (6.2% and 2.7%, respectively). Model B resulted in sensitivity/NPV of 97.5%/98.3% and 96.1%/89.4%, while efficacy increased to 14.2% and 10.4%, respectively. Model C resulted in sensitivity/NPV of 96.7%/98.6% and 95.2%/91.3%, with a further increase in efficacy to 23.1% and 15.5%, respectively. Conclusion A triage algorithm for the identification of low-risk chest pain patients exclusively based on simple clinical variables provided reasonable performance characteristics possibly justifying delayed rather than immediate evaluation in the emergency department.

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What decides the suspicion of acute coronary syndrome in acute chest pain patients?

BMC Emergency Medicine ◽

10.1186/1471-227x-14-9 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 6

Author(s):

Alexander Kamali ◽

Martin Söderholm ◽

Ulf Ekelund

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Acute Chest Pain ◽

Coronary Syndrome ◽

Pain Patients

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Predictive Value of a 6-Hour Ecg/Troponin Protocol in Patients with Chest Pain

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490790301000303 ◽

2003 ◽

Vol 10 (3) ◽

pp. 146-152 ◽

Cited By ~ 1

Author(s):

CY Man ◽

PA Cameron ◽

WL Cheung

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Troponin T ◽

Low Risk ◽

Chinese Patients ◽

Initial Assessment ◽

Coronary Syndrome ◽

Pain Patients

Introduction Patients presenting with chest pain and considered to be at low risk of acute coronary syndrome (ACS) may still have coronary heart disease. The potential risk of sudden cardiac death due to arrhythmias or progression to acute myocardial infarction still exists. To minimize this risk, we have designed a 6-hour risk stratification protocol for patients with a low risk of acute myocardial infarction on initial assessment in the Accident and Emergency Department (AED). Materials & Methods This was a retrospective observational study with the aim of determining the risk of adverse cardiovascular events in chest pain patients attending an AED. These patients were subject to an ECG and cardiac troponin T tests (cTnT) at 0 hour and at 6 hours (if the two tests were negative at 0 hour), and were put under observation in the AED observation ward during the same period. The main outcome measures were adverse cardiac events at 30 days. Results A total of 371 Chinese patients considered to have low risk of ACS were recruited into the protocol. Troponin T tested positive in 19 patients (5.1%) at 0 hour and 8 patients (2.2%) at 6 hours. Amongst the 332 patients that were discharged directly from the AED, there were no re-admissions for cardiac-related deaths, acute myocardial infarction, arrhythmia or heart failure. Conclusion The 6-hour ECG and troponin T observation protocol is a useful tool to allow safe discharge of chest pain patients who are at low risk of acute coronary syndrome.

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COMPARATIVE ANALYSIS OF VARIOUS RISK ASSESSMENT SCORES FOR LOW RISK ACUTE CORONARY SYNDROME IN AN INDIAN SCENARIO – AN ED BASED OBSERVATIONAL STUDY.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i11.746 ◽

2019 ◽

Vol 3 (11) ◽

Author(s):

Zahid Shaikh ◽

V. S. Shinde ◽

Sumalya Tripathi ◽

Dhiraj Jadhav ◽

Ishan Lamba ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Tertiary Care ◽

Acute Chest Pain ◽

Industrial Area ◽

Low Risk ◽

Cardiac Biomarkers ◽

Assessment Scores ◽

Heart Score ◽

Coronary Syndrome

Chest pain is one of the most common presentation to emergency department (ED). The misdiagnosis or over-diagnosis of patients with acute chest pain can be associated with serious clinical events or is time-consuming and this places a heavy burden on overcrowded and resource constraint ED. To help overcome this issue various scores are formed to rule out acute coronary syndrome (ACS) in these patients. Those who do not meet the criteria of high risk ACS like raised cardiac biomarkers, ECG changes, etc are labeled as low risk ACS. These patients form the majority of patients. A multitude of risk score have been formulated to predict the outcome and risk stratify patients with chest pain. Our objective was to evaluate the utility of these score in Indian setting in low risk ACS patients. We studied the various risk prediction score of 100 patients presenting to the ED of tertiary care teaching institute in an urban industrial area with low risk ACS. The scores that were calculated included HEART, TIMI, ADAPT, GRACE, NACPR and EDACS. Of all the scores only the HEART score correlated well with identifying those who required further testing. Taking a score of less than 3 as a marker of low risk ACS we get a sensitivity of 95.83% (95CI - 89.67% to 98.85%) and specificity of 100%. The PPV is 100% and accuracy of 96%. All other scores were either not specific enough or had limited utility. Keywords: Low risk ACS, ACS, HEART, TIMI, ADAPT, GRACE, NACPR, EDACS

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Chest pain and chest pain units

10.1093/med/9780199687039.003.0008 ◽

2015 ◽

Author(s):

Eric Durand ◽

Aures Chaib ◽

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 provided an environment where serial electrocardiograms, cardiac biomarkers, and provocative testing could be performed to rule out an acute coronary syndrome. Eligible candidates included the majority of patients with non-diagnostic electrocardiograms and normal troponin measurements. 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 very low in Europe.

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