Ehsan Khan1,2, Kristina Lambrakis1,2, Andrew Blyth1,2, Anil Seshadri1,2, Michael J R Edmonds2, Tom Briffa3, Louise A Cullen4,5,6, Stephen Quinn7,8, Matthew Horsfall1,2, Erin Morton1, John K French9, Cynthia Papendick3, Adam J Nelson2,10,11, Derek P Chew1,2,3. 1. College of Medicine & Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia. 2. South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia. 3. School of Population and Global Health, University of Western Australia, Clifton Street, Nedlands, Perth, WA 6009, Australia. 4. Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD 4029, Australia. 5. School of Public Health, Queensland University of Technology, George Street, Brisbane, QLD 4000, Australia. 6. School of Medicine, University of Queensland, St Lucia, Brisbane, QLD 4072, Australia. 7. Department of Statistics, Swinburne University of Technology, John Street, Hawthorne, Melbourne, VIC 3122, Australia. 8. Department of Health Science and Biostatistics, Swinburne University of Technology, John Street, Hawthorne, Melbourne, VIC 3122, Australia. 9. Department of Cardiology, Liverpool Hospital, Elizabeth & Goulburn Street, Liverpool, Sydney, NSW 2170, Australia. 10. South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia. 11. School of Medicine, University of Adelaide, North Terrrace, Adelaide, SA 5000, Australia.
Abstract
AIMS: High-sensitivity cardiac troponin strategies can provide risk stratification in patients with suspected acute coronary syndrome (ACS) in the emergency department (ED). This study evaluated whether clinical risk scoring improves the classification performance of a rule-out profile in suspected ACS. METHODS AND RESULTS: Patients presenting to ED with suspected ACS as part of the RAPID-TnT trial randomized to the intervention arm were included. Results ≥5 ng/L were available for all participants in this analysis. We evaluated the Thrombolysis In Myocardial Infarction (TIMI) risk score, History ECG Age Risk factors Troponin (HEART) score, and Emergency Department Assessment of Chest pain Score (EDACS) in addition to a rule-out profile based on the 0/1-h high-sensitivity cardiac troponin T protocol (<5 ng/L or ≤12 ng/L and a change of <3 ng/L at 1-h) using test performance parameters focusing on low-risk groups to identify the primary endpoint (TIMI ≤ 1, HEART ≤ 3, EDACS < 16). Primary endpoint was a composite of type 1/2 myocardial infarction (MI) at index presentation and all-cause mortality or type 1/2 MI at 30 days. A total of 3378 participants were enrolled between August 2015 and April 2019 of which 108 were ineligible/withdrew consent (intervention arm: n = 1638). Sensitivity, specificity, negative predictive value (NPV), and area under the curve (AUC) of the rule-out profile was 94.4%, 76.8%, 99.6%, and 0.86, respectively with 72.9% identified as 'low-risk'. Adding the clinical risk scores did not improve the sensitivity, NPV, or AUC with significantly lower specificity and 'low-risk' classified participants. CONCLUSIONS: Addition of clinical risk scores to rule-out profile did not demonstrate improved classification performance for identifying the composite of type 1/2 MI at index presentation and all-cause mortality or type 1/2 MI at 30 days. CLINICAL TRIALS REGISTRATION: URL: https://www.anzctr.org.au. Reg. No. ACTRN12615001379505. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: High-sensitivity cardiac troponin strategies can provide risk stratification in patients with suspected acute coronary syndrome (ACS) in the emergency department (ED). This study evaluated whether clinical risk scoring improves the classification performance of a rule-out profile in suspected ACS. METHODS AND RESULTS: Patients presenting to ED with suspected ACS as part of the RAPID-TnT trial randomized to the intervention arm were included. Results ≥5 ng/L were available for all participants in this analysis. We evaluated the Thrombolysis In Myocardial Infarction (TIMI) risk score, History ECG Age Risk factors Troponin (HEART) score, and Emergency Department Assessment of Chest pain Score (EDACS) in addition to a rule-out profile based on the 0/1-h high-sensitivity cardiac troponin T protocol (<5 ng/L or ≤12 ng/L and a change of <3 ng/L at 1-h) using test performance parameters focusing on low-risk groups to identify the primary endpoint (TIMI ≤ 1, HEART ≤ 3, EDACS < 16). Primary endpoint was a composite of type 1/2 myocardial infarction (MI) at index presentation and all-cause mortality or type 1/2 MI at 30 days. A total of 3378 participants were enrolled between August 2015 and April 2019 of which 108 were ineligible/withdrew consent (intervention arm: n = 1638). Sensitivity, specificity, negative predictive value (NPV), and area under the curve (AUC) of the rule-out profile was 94.4%, 76.8%, 99.6%, and 0.86, respectively with 72.9% identified as 'low-risk'. Adding the clinical risk scores did not improve the sensitivity, NPV, or AUC with significantly lower specificity and 'low-risk' classified participants. CONCLUSIONS: Addition of clinical risk scores to rule-out profile did not demonstrate improved classification performance for identifying the composite of type 1/2 MI at index presentation and all-cause mortality or type 1/2 MI at 30 days. CLINICAL TRIALS REGISTRATION: URL: https://www.anzctr.org.au. Reg. No. ACTRN12615001379505. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Luke P Dawson; Emily Andrew; Ziad Nehme; Jason Bloom; Danny Liew; Shelley Cox; David Anderson; Michael Stephenson; Jeffrey Lefkovits; Andrew J Taylor; David Kaye; Louise Cullen; Karen Smith; Dion Stub Journal: Int J Cardiol Heart Vasc Date: 2022-04-28
Authors: Ayesha Khan; Muhammad S Saleem; Keith D Willner; Luke Sullivan; Elsie Yu; Osama Mahmoud; Amro Alsaid; Martin E Matsumura Journal: JAMA Netw Open Date: 2022-08-01