Performance of the EDACS-ADP incorporating high-sensitivity troponin assay:Do components of major adverse cardiac events matter?
10.5847/wjem.j.1920-8642.2024.032
- Author:
Yoo YEDALM
1
;
Ahn SHIN
;
Chae BORA
;
Kim Young WON
Author Information
1. Department of Emergency Medicine,Asan Medical Center,University of Ulsan College of Medicine,Seoul 05505,Republic of Korea
- Keywords:
Chest pain;
Major adverse cardiac event;
Acute coronary syndrome;
Emergency department
- From:
World Journal of Emergency Medicine
2024;15(3):175-180
- CountryChina
- Language:Chinese
-
Abstract:
BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients presenting with chest pain to the emergency department,was developed using a contemporary troponin assay.This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina(MACE I and Ⅱ,respectively). METHODS:A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed.The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value. RESULTS:Of the 1,304 patients prospectively enrolled,399(30.6％;95％confidence interval[95％CI]:27.7％-33.8％)were considered low-risk using the EDACS-ADP.Among them,the rates of MACE I andⅡ were 1.3％(5/399)and 1.0％(4/399),respectively.The EDACS-ADP showed sensitivities and negative predictive values of 98.8％(95％CI:97.2％-99.6％)and 98.7％(95％CI:97.0％-99.5％)for MACE I and 98.7％(95％CI:96.8％-99.7％)and 99.0％(95％CI:97.4％-99.6％)for MACE Ⅱ,respectively. CONCLUSION:EDACS-ADP could help identify patients as safe for early discharge.However,when unstable angina was added to the outcome,the 30-day MACE rate among the designated low-risk patients remained above the level acceptable for early discharge without further evaluation.
