2-hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the adapt trial Full Text
JACC - Journal of the American College of Cardiology, 05/29/2012
Than M et al. – Using the accelerated diagnostic protocol (ADP), a large group of patients was successfully identified as at low short–term risk of a major adverse cardiac event (MACE) and therefore suitable for rapid discharge from the emergency department with early follow–up. This approach could decrease the observation period required for some patients with chest pain.Methods
- This prospective observational study tested an ADP that included pre–test probability scoring by the Thrombolysis In Myocardial Infarction (TIMI) score, electrocardiography, and 0 + 2 h values of laboratory troponin I as the sole biomarker.
- Patients presenting with chest pain due to suspected ACS were included.
- The primary endpoint was major adverse cardiac event (MACE) within 30 days.
- Of 1,975 patients, 302 (15.3%) had a MACE.
- The ADP classified 392 patients (20%) as low risk.
- One (0.25%) of these patients had a MACE, giving the ADP a sensitivity of 99.7% (95% confidence interval [CI]: 98.1% to 99.9%), negative predictive value of 99.7% (95% CI: 98.6% to 100.0%), specificity of 23.4% (95% CI: 21.4% to 25.4%), and positive predictive value of 19.0% (95% CI: 17.2% to 21.0%).
- Many ADP negative patients had further investigations (74.1%), and therapeutic (18.3%) or procedural (2.0%) interventions during the initial hospital attendance and/or 30–day follow–up.