Key result
ACSD score outperforms TIMI alone for diagnosing ACS with an AUC of 0.85.
Why the study?
Does the ACSD score improve the diagnostic accuracy of acute coronary syndrome compared to the TIMI score alone in ED patients with chest pain, non-diagnostic ECG, and normal troponin?
Cohort (n=809)
No
Does the ACSD score improve the diagnostic accuracy of acute coronary syndrome compared to the TIMI score alone in ED patients with chest pain, non-diagnostic ECG, and normal troponin?
A novel ACS diagnostic score combining TIMI and chest pain characteristics demonstrated good discrimination and excellent negative predictive value for ruling out ACS in ED patients with non-diagnostic ECG and normal troponin.
Answers are grounded in this paper and cite their sources.
May support ACS rule-out in ED chest pain with nondiagnostic tests; leaves open prospective validation before practice change.
BACKGROUND: Acute coronary syndrome (ACS) represents a difficult diagnostic challenge in patients with undifferentiated chest pain. There is a need for a valid clinical score to improve diagnostic accuracy. OBJECTIVES: To compare the performance of a model combining the Thrombolysis in Myocardial Infarction (TIMI) score and a score describing chest pain (ACS diagnostic score: ACSD score) with that of both scores alone in the diagnosis of ACS in ED patients with chest pain associated with a non-diagnostic ECG and normal troponin. METHODS: In this observational cohort study, we enrolled 809 patients admitted to a chest pain unit with normal ECG and normal troponin. They were prospectively evaluated in order to calculate TIMI score, chest pain characteristics score and ACSD score. Diagnosis of ACS was the primary outcome and defined on the basis of 2 cardiologists after reviewing the patient medical records and follow-up data. Mortality and major cardiovascular events were followed for 1 month for patients discharged directly from ED. Discriminative power of scores was evaluated by the area under the ROC curve. RESULTS: ACS was confirmed in 90 patients (11.1%). The area under the ROC curve for ACSD score was 0.85 (95% CI 0.80 to 0.90) compared with 0.74 (95% CI 0.67 to 0.81) for TIMI and 0.79 (95% CI 0.74 to 0.84) for chest pain characteristics score. A threshold value of 9 appeared to optimise sensitivity (92%) and negative predictive value (99%) without excessively compromising specificity (62%) and positive predictive value (23%). CONCLUSIONS: The ACSD score showed a good discrimination performance and an excellent negative predictive value which allows safely ruling out ACS in ED patients with undifferentiated chest pain. Our findings should be validated in a larger multicentre study.
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Boubaker et al. (2015) conducted a cohort in Acute chest pain (n=809). ACSD score vs. TIMI score and chest pain characteristics score alone was evaluated on Diagnosis of acute coronary syndrome (ACS) (AUC 0.85, 95% CI 0.80-0.90). The ACSD score demonstrated strong discriminative power for diagnosing acute coronary syndrome compared to the TIMI score alone.
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