Key result
An ACI-TIPI score of < 20% demonstrated 100% sensitivity and 100% negative predictive value for 30-day major adverse cardiac events in emergency department patients with acute chest pain.
Why the study?
Does the ACI-TIPI score predict 30-day major adverse cardiac events in Emergency Department patients with acute chest pain?
Cohort (n=144)
Yes
Does the ACI-TIPI score predict 30-day major adverse cardiac events in Emergency Department patients with acute chest pain?
Effect estimate: c-statistic 0.69 (95% CI 0.59-0.80)
p-value: p=<0.01
An ACI-TIPI score of <20 may identify Emergency Department patients with acute chest pain at very low risk for 30-day MACE, potentially allowing for safe outpatient management.
May support low-risk ED chest pain stratification; leaves open prospective validation before guiding discharge.
BACKGROUND: We sought to evaluate the test characteristics of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) in relation to 30-day major adverse cardiac events (MACE) among patients who presented to the Emergency Department with symptoms suggestive of an acute coronary syndrome. We then examined the test characteristics of various dichotomous ACI-TIPI cut points. METHODS: We prospectively recruited a cohort of Emergency Department (ED) patients with acute chest pain at two urban university hospitals between June and September 2006. Upon enrollment, baseline demographics and cardiac risk factors were collected. An electrocardiogram (ECG) was performed and analyzed with the built-in ACI-TIPI multiple regression model software. An ACI-TIPI probability score was recorded for each patient. Diagnostic test characteristics of ACI-TIPI for MACE (non-ST elevation myocardial infarction (NSTEMI), percutaneous coronary intervention, coronary artery bypass grafting, and all-cause mortality) within 30 days were determined. RESULTS: Of 144 patients enrolled (mean age 59.1 ± 14.1 years, 59% men), 19 (13%) patients suffered MACE within 30 days. Receiver-operating characteristics (ROC) for ACI-TIPI yielded a c-statistic of 0.69 (95% CI 0.59-0.80, p < 0.01). An ACI-TIPI score of ≥ 20 had 100% sensitivity (95% CI 82-100), 100% negative predictive value (95% CI 86-100), and 21% specificity (14-31%). CONCLUSIONS: These preliminary results suggest that, while ACI-TIPI has limited discriminatory value for MACE overall, a score of < 20 may have 30-day prognostic utility to allow for safe outpatient management in patients with acute chest pain.
No takes yet. Share an insight, caveat, or question.
Ilgen et al. (2011) conducted a cohort in Acute chest pain / suspected acute coronary syndrome (n=144). Acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) vs. Low ACI-TIPI score was evaluated on 30-day major adverse cardiac events (MACE) (c-statistic 0.69, 95% CI 0.59-0.80, p=<0.01). An ACI-TIPI score of < 20% demonstrated 100% sensitivity and 100% negative predictive value for 30-day major adverse cardiac events in emergency department patients with acute chest pain.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: