![]() 2-5 However, by not including those patients who require urgent revascularization, this singular endpoint does not represent the full spectrum of clinically relevant acute coronary syndromes (ACS). 6-8 Those protocols employing low cut-off values for high-sensitivity troponin have consistently demonstrated a high diagnostic accuracy for acute myocardial infarction. 2-5 The second uses conventional cut-offs for high-sensitivity troponin assays in combination with chest pain risk scores. The first utilizes the ability of high-sensitivity troponin assays to measure low concentrations of troponin with cut-off values below the 99th percentile. Such rapid rule-out strategies may serve to substantially reduce hospital admissions and have major benefits for healthcare providers.Ĭurrently, rapid rule-out strategies may be broadly separated into two distinct categories. These patients may be suitable for early discharge from the ED with outpatient follow-up. Much of the recent focus within published literature has been on the use of high-sensitivity troponin assays in the identification of low-risk emergency department (ED) patients presenting with suspected cardiac chest pain who are at low risk of adverse cardiac events. 1 The high precision of these assays at very low concentrations, in comparison with contemporary assays, enables accurate quantification of troponin in most healthy people. High-sensitivity troponin assays have a coefficient of variation of 10% or less at the 99th percentile (the upper limit of the reference population) and are able to detect cardiac troponin in at least 50% of the reference population. All rights reserved.High-sensitivity troponin assays have the potential to offer clinicians across the United States novel diagnostics strategies in the assessment of patients with chest pain and should be widely available subject to FDA approval. The HEART score outperformed the GRACE and TIMI scores in discriminating between those with and without MACE in chest pain patients, and identified the largest group of low-risk patients at the same level of safety.Īcute coronary syndrome Chest pain Clinical prediction rule GRACE score HEART score TIMI score.Ĭopyright © 2016 The Authors. The TIMI score identified no "low risk" patients at this safety level. At an absolute level of safety of at least 98% sensitivity, the GRACE score identified 231 patients as "low risk" in which 2.2% a MACE was missed the HEART score identified 381 patients as "low risk" with 0.8% missed MACE. Additionally, the number of low-risk patients identified by each score were compared at a fixed level of safety of at least 95% or 98% sensitivity. Performance of the scores was compared by calculating AUC curves. The GRACE and TIMI score were calculated based on prospectively collected data. ![]() The HEART score was determined by the treating physician at the ED. The primary outcome was MACE within 6weeks. The performance of the GRACE, HEART and TIMI scores were compared in predicting the probability of major adverse cardiac events (MACE) in chest pain patients presenting at the emergency department (ED), in particular their ability to identify patients at low risk.Ĭhest pain patients presenting at the ED in nine Dutch hospitals were included. ![]()
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