Yo Sep Shin1, Shin Ahn2, Youn-Jung Kim1, Seung Mok Ryoo1, Chang Hwan Sohn1, Won Young Kim1. 1. Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 2. Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: ans1023@gmail.com.
Abstract
OBJECTIVE: We validated prior emergency department (ED) assessments of the chest pain score accelerated diagnostic pathway (EDACS-ADP) in Korean patients. This score is designed to discriminate patients at a low risk of a major adverse cardiac event (MACE) from those with a potentially more serious condition. METHODS: We retrospectively evaluated 1273 patients who had presented at our ED with chest pain or symptoms of a suspected coronary artery disease and who underwent coronary computed tomographic angiography from January 2017 to December 2018. These cases had been classified as low or high risk using the EDACS-ADP. The primary outcome was a MACE onset within 30 days of presentation. RESULTS: Of the total study patients, 448 (35.2%) were classified as low risk by the EDACS-ADP and 5 cases (1.1%) of MACE arose. Overall, 221 patients in the study population (17.3%) developed a MACE. The sensitivity, and negative predictive values of the EDACS-ADP were 97.7% (95% CI 94.8-99.3), and 98.9% (97.4-99.5), respectively. CONCLUSION: The sensitivity and negative predictive values for the EDACS-ADP were high in Korean patients presenting at the ED. However, the MACE rate among low-risk patients is higher than that considered acceptable by the majority of ED physicians for patients that are to be discharged without further evaluation. Further studies may be warranted for the successful application of the EDACS-ADP.
OBJECTIVE: We validated prior emergency department (ED) assessments of the chest pain score accelerated diagnostic pathway (EDACS-ADP) in Korean patients. This score is designed to discriminate patients at a low risk of a major adverse cardiac event (MACE) from those with a potentially more serious condition. METHODS: We retrospectively evaluated 1273 patients who had presented at our ED with chest pain or symptoms of a suspected coronary artery disease and who underwent coronary computed tomographic angiography from January 2017 to December 2018. These cases had been classified as low or high risk using the EDACS-ADP. The primary outcome was a MACE onset within 30 days of presentation. RESULTS: Of the total study patients, 448 (35.2%) were classified as low risk by the EDACS-ADP and 5 cases (1.1%) of MACE arose. Overall, 221 patients in the study population (17.3%) developed a MACE. The sensitivity, and negative predictive values of the EDACS-ADP were 97.7% (95% CI 94.8-99.3), and 98.9% (97.4-99.5), respectively. CONCLUSION: The sensitivity and negative predictive values for the EDACS-ADP were high in Korean patients presenting at the ED. However, the MACE rate among low-risk patients is higher than that considered acceptable by the majority of ED physicians for patients that are to be discharged without further evaluation. Further studies may be warranted for the successful application of the EDACS-ADP.