2-hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: The ADAPT trial

Than, Martin, Cullen, Louise, Aldous, Sally, Parsonage, William A., Reid, Christopher M., Greenslade, Jaimi, Flaws, Dylan, Hammett, Christopher J., Beam, Daren M., Ardagh, Michael W., Troughton, Richard, Brown, Anthony F.T., George, Peter, Florkowski, Christopher M., Kline, Jeffrey A., Peacock, W. Frank, Maisel, Alan S., Lim, Swee Han, Lamanna, Arvin and Richards, A. Mark (2012) 2-hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: The ADAPT trial. Journal of the American College of Cardiology, 59 23: 2091-2098.

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Author Than, Martin
Cullen, Louise
Aldous, Sally
Parsonage, William A.
Reid, Christopher M.
Greenslade, Jaimi
Flaws, Dylan
Hammett, Christopher J.
Beam, Daren M.
Ardagh, Michael W.
Troughton, Richard
Brown, Anthony F.T.
George, Peter
Florkowski, Christopher M.
Kline, Jeffrey A.
Peacock, W. Frank
Maisel, Alan S.
Lim, Swee Han
Lamanna, Arvin
Richards, A. Mark
Title 2-hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: The ADAPT trial
Journal name Journal of the American College of Cardiology   Check publisher's open access policy
ISSN 0735-1097
1558-3597
Publication date 2012-06
Sub-type Article (original research)
DOI 10.1016/j.jacc.2012.02.035
Volume 59
Issue 23
Start page 2091
End page 2098
Total pages 8
Place of publication San Diego, CA, United States
Publisher Elsevier
Collection year 2013
Language eng
Formatted abstract Objectives: The purpose of this study was to determine whether a new accelerated diagnostic protocol (ADP) for possible cardiac chest pain could identify low-risk patients suitable for early discharge (with follow-up shortly after discharge).

Background: Patients presenting with possible acute coronary syndrome (ACS), who have a low short-term risk of adverse cardiac events may be suitable for early discharge and shorter hospital stays.

Methods: This prospective observational study tested an ADP that included pre-test probability scoring by the Thrombolysis In Myocardial Infarction (TIMI) score, electrocardiography, and 0 + 2 h values of laboratory troponin I as the sole biomarker. Patients presenting with chest pain due to suspected ACS were included. The primary endpoint was major adverse cardiac event (MACE) within 30 days.

Results: Of 1,975 patients, 302 (15.3%) had a MACE. The ADP classified 392 patients (20%) as low risk. One (0.25%) of these patients had a MACE, giving the ADP a sensitivity of 99.7% (95% confidence interval [CI]: 98.1% to 99.9%), negative predictive value of 99.7% (95% CI: 98.6% to 100.0%), specificity of 23.4% (95% CI: 21.4% to 25.4%), and positive predictive value of 19.0% (95% CI: 17.2% to 21.0%). Many ADP negative patients had further investigations (74.1%), and therapeutic (18.3%) or procedural (2.0%) interventions during the initial hospital attendance and/or 30-day follow-up.

Conclusions: Using the ADP, a large group of patients was successfully identified as at low short-term risk of a MACE and therefore suitable for rapid discharge from the emergency department with early follow-up. This approach could decrease the observation period required for some patients with chest pain. (An observational study of the diagnostic utility of an accelerated diagnostic protocol using contemporary central laboratory cardiac troponin in the assessment of patients presenting to two Australasian hospitals with chest pain of possible cardiac origin.
Keyword Acute myocardial infarction
Troponins
Sensitivity and specificity
Acute coronary syndrome
Standardized reporting guidelines
Timi risk score
Myocardial-infarction
Emergency-department
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online: 9 May 2012.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
 
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