Key result
The EDACS-ADP incorporating high-sensitivity troponin I demonstrated a sensitivity of 98.8% and negative predictive value of 98.7% for 30-day MACE when unstable angina was included.
Why the study?
The EDACS-ADP was developed using a contemporary troponin assay; this study aimed to validate and compare its performance incorporating high-sensitivity cardiac troponin I between patients with 30-day MACE with and without unstable angina.
Does the EDACS-ADP incorporating high-sensitivity troponin I accurately identify patients at low risk for 30-day MACE among ED patients with chest pain?
Observational (n=1,304)
No
Does the EDACS-ADP incorporating high-sensitivity troponin I accurately identify patients at low risk for 30-day MACE among ED patients with chest pain?
The EDACS-ADP using high-sensitivity troponin I can identify low-risk chest pain patients for early discharge, but the missed MACE rate exceeds the acceptable 1% threshold if unstable angina is included in the outcome.
Should not yet change early-discharge practice if UA counts as MACE; leaves open hs-cTnI EDACS-ADP safety.
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: : 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.
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Yoo et al. (2024) conducted an observational in Chest pain suggestive of acute coronary syndrome (n=1,304). EDACS-ADP incorporating high-sensitivity troponin I was evaluated on Sensitivity for 30-day MACE including unstable angina (MACE I) (Sensitivity 98.8%, 95% CI 97.2-99.6). The EDACS-ADP incorporating high-sensitivity troponin I demonstrated a sensitivity of 98.8% and negative predictive value of 98.7% for 30-day MACE when unstable angina was included.
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