How useful are the Heart Foundation risk criteria for assessment of emergency department patients with chest pain
Emergency Medicine Australasia, 06/08/2012
Kelly AM – The Heart Foundation risk classification shows only fair predictive performance for MI, 7 and 30 day major adverse cardiac events (MACE). With specificity of approximately 50%, the recommendation for coronary care admission for all high–risk patients is hard to justify.Methods
- A planned sub-study of a prospective observational study of adult patients with potentially cardiac chest pain who underwent evaluation for acute coronary syndrome (ACS) was conducted.
- Data collected included demographical, clinical, ECG, biomarker and outcome data.
- Outcome of interest was diagnostic utility of the classification system for ACS or myocardial infarction (MI) at index presentation and major adverse cardiac events (MACE) within 7 and 30days.
- MACE included death, cardiac arrest, revascularization, cardiogenic shock, arrhythmia and prevalent (cause of presentation) and incident (occurring within the follow-up period) MI.
- Analysis was by descriptive and receiver-operator curve analyses.
- Seven hundred and sixty-eight patients were studied; 109 had MI (14.2%, 95% confidence interval [CI] 11.9-16.8%).
- There were 88 MACE at 7days (13.5%, 95% CI 11.1-16.4%) and 93 MACE at 30days (14.4%%, 95% CI 11.9-17.3%).
- Diagnostic performance (c-statistic) of the National Heart Foundation risk classification for ACS, MI, 7 and 30day MACE was 0.74 for each (95% CI 0.71-0.77).
- Although sensitivity of the high-risk classification for MI, 7 and 30day MACE was high (99-100%), specificity was low (48-50%).