A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): A prospective observational validation study

Than, Martin, Cullen, Louise, Reid, Christopher M., Lim, Swee Han, Aldous, Sally, Ardagh, Michael W., Peacock, W. Frank, Parsonage, William A., Ko, Hiu Fai, Kasliwal, Ravi R., Bansal, Manish, Soerianata, Sunarya, Hu, Dayi, Ding, Rongjing, Hua, Qi, Seok-Min, Kang, Sritara, Piyamitr, Sae-Lee, Ratchanee, Chiu, Te-Fa, Tsai, Kuang-Chau, Chu, Fang-Yeh, Chen, Wei-Kung, Chang, Wen-Han, Flaws, Dylan F., George, Peter M. and Richards, A. Mark (2011) A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): A prospective observational validation study. The Lancet, 377 9771: 1077-1084.

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Author Than, Martin
Cullen, Louise
Reid, Christopher M.
Lim, Swee Han
Aldous, Sally
Ardagh, Michael W.
Peacock, W. Frank
Parsonage, William A.
Ko, Hiu Fai
Kasliwal, Ravi R.
Bansal, Manish
Soerianata, Sunarya
Hu, Dayi
Ding, Rongjing
Hua, Qi
Seok-Min, Kang
Sritara, Piyamitr
Sae-Lee, Ratchanee
Chiu, Te-Fa
Tsai, Kuang-Chau
Chu, Fang-Yeh
Chen, Wei-Kung
Chang, Wen-Han
Flaws, Dylan F.
George, Peter M.
Richards, A. Mark
Title A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): A prospective observational validation study
Journal name The Lancet   Check publisher's open access policy
ISSN 0140-6736
1474-547X
Publication date 2011-03-26
Year available 2011
Sub-type Article (original research)
DOI 10.1016/S0140-6736(11)60310-3
Volume 377
Issue 9771
Start page 1077
End page 1084
Total pages 8
Place of publication London, U.K.
Publisher The Lancet Publishing Group
Collection year 2012
Language eng
Formatted abstract Background: Patients with chest pain contribute substantially to emergency department attendances, lengthy hospital stay, and inpatient admissions. A reliable, reproducible, and fast process to identify patients presenting with chest pain who have a low short-term risk of a major adverse cardiac event is needed to facilitate early discharge. We aimed to prospectively validate the safety of a predefined 2-h accelerated diagnostic protocol (ADP) to assess patients presenting to the emergency department with chest pain symptoms suggestive of acute coronary syndrome.

Methods:
This observational study was undertaken in 14 emergency departments in nine countries in the Asia-Pacific region, in patients aged 18 years and older with at least 5 min of chest pain. The ADP included use of a structured pre-test probability scoring method (Thrombolysis in Myocardial Infarction [TIMI] score), electrocardiograph, and point-of-care biomarker panel of troponin, creatine kinase MB, and myoglobin. The primary endpoint was major adverse cardiac events within 30 days after initial presentation (including initial hospital attendance). This trial is registered with the Australia-New Zealand Clinical Trials Registry, number ACTRN12609000283279.

Findings
: 3582 consecutive patients were recruited and completed 30-day follow-up. 421 (11·8%) patients had a major adverse cardiac event. The ADP classified 352 (9·8%) patients as low risk and potentially suitable for early discharge. A major adverse cardiac event occurred in three (0·9%) of these patients, giving the ADP a sensitivity of 99·3% (95% CI 97·9—99·8), a negative predictive value of 99·1% (97·3—99·8), and a specificity of 11·0% (10·0—12·2).

Interpretation: This novel ADP identifies patients at very low risk of a short-term major adverse cardiac event who might be suitable for early discharge. Such an approach could be used to decrease the overall observation periods and admissions for chest pain. The components needed for the implementation of this strategy are widely available. The ADP has the potential to affect health-service delivery worldwide.

Funding
: Alere Medical (all countries), Queensland Emergency Medicine Research Foundation and National Health and Medical Research Council (Australia), Christchurch Cardio-Endocrine Research Group (New Zealand), Medquest Jaya Global (Indonesia), Science International (Hong Kong), Bio Laboratories Pte (Singapore), National Heart Foundation of New Zealand, and Progressive Group (Taiwan).
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Publication date: 26 March-1 April 2011.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Medicine Publications
School of Nursing and Midwifery Publications
 
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Created: Thu, 24 Mar 2011, 20:42:38 EST by Mr Dylan Flaws on behalf of School of Nursing and Midwifery