Comparison of early biomarker strategies with the Heart Foundation of Australia/Cardiac Society of Australia and New Zealand guidelines for risk stratification of ED patients with chest pain

Cullen, Louise, Parsonage, William A., Greenslade, Jaimi, Lamanna, Arvin, Hammett, Christopher J., Than, Martin, Ungerer, Jacobus P. J., Chu, Kevin, O'Kane, Shanen and Brown, Anthony F. T. (2012) Comparison of early biomarker strategies with the Heart Foundation of Australia/Cardiac Society of Australia and New Zealand guidelines for risk stratification of ED patients with chest pain. Emergency Medicine Australasia, 24 6: 595-603. doi:10.1111/1742-6723.12008

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Author Cullen, Louise
Parsonage, William A.
Greenslade, Jaimi
Lamanna, Arvin
Hammett, Christopher J.
Than, Martin
Ungerer, Jacobus P. J.
Chu, Kevin
O'Kane, Shanen
Brown, Anthony F. T.
Title Comparison of early biomarker strategies with the Heart Foundation of Australia/Cardiac Society of Australia and New Zealand guidelines for risk stratification of ED patients with chest pain
Journal name Emergency Medicine Australasia   Check publisher's open access policy
ISSN 1742-6731
1742-6723
Publication date 2012-12
Sub-type Article (original research)
DOI 10.1111/1742-6723.12008
Volume 24
Issue 6
Start page 595
End page 603
Total pages 9
Place of publication Richmond, Vic., Australia
Publisher Wiley-Blackwell Publishing
Collection year 2013
Language eng
Formatted abstract
Objectives: To compare cardiac risk stratification using a 0 and 2 h point-of-care (POC) cardiac troponin (cTn), 0 and 2 h POC multi-biomarkers against the 0 and 6 h laboratory cTn reference standard.
Methods: A prospective observational study of ED patients presenting with chest pain was performed. Patients were risk stratified and treated as per the Heart Foundation of Australia/Cardiac Society of Australia and New Zealand (HF-A/CS-ANZ) guidelines using the 0 and 6 h laboratory cTn (T6). Patients were further stratified using a 0 and 2 h POC cTn (T2) plus 0 and 2 h POC multi-biomarkers (cTn, creatine kinase-MB, myoglobin) (M2). The T6, T2 and M2 strategies were compared using the 30-day major adverse cardiac events as the primary outcome.
Results: Seven hundred and four patients (median age 54 years, male 62.1%) were enrolled. Using the T6 reference standard, 2%, 61% and 37% were stratified as low, intermediate and high risk, respectively. The 30-day event rates were 0%, 3.5% and 28.6%, respectively. The T2 strategy stratified 1.5%, 57% and 41% as low, intermediate and high risk, respectively, with 30-day event rates of 0%, 4.2% and 24.8%, respectively. The M2 strategy resulted in significantly different risk distribution with 1%, 40% and 59% stratified as low, intermediate and high risk, respectively, with 30-day event rates of 0%, 3.9% and 18.8%, respectively.
Conclusion: Using a 2 h POC cTn-only biomarker strategy with the HF-A/CS-ANZ guidelines accurately identified a population at intermediate risk of 30-day events in whom further objective testing might be accelerated, allowing subsequent early discharge of the majority of this cohort. Within 2 h of presentation a high risk population could be identified in whom early management, including admission, was required.
Keyword Biomarker
Chest pain
Emergency medicine
Risk stratification
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
 
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Created: Mon, 10 Dec 2012, 18:18:09 EST by Sia Athanasas on behalf of Anaesthesiology and Critical Care - RBWH