Performance of the EDACS-ADP incorporating highsensitivity troponin assay: Do components of major adverse cardiac events matter?

BACKGROUND

The accelerated diagnostic protocol (ADP) using the Emergency Department Assessment of Chest pain Score (EDACS-ADP), a tool to identify patients at low risk of a major adverse cardiac event (MACE) among patients presenting with chest pain to the emergency department, was developed using a contemporary troponin assay. This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina (MACE I and II, respectively).

METHODS

A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed. The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value.

RESULTS

Of the 1,304 patients prospectively enrolled, 399 (30.6%; 95% confidence interval [95% ]: 27.7%-33.8%) were considered low-risk using the EDACS-ADP. Among them, the rates of MACE I and II were 1.3% (5/399) and 1.0% (4/399), respectively. The EDACS-ADP showed sensitivities and negative predictive values of 98.8% (95% : 97.2%-99.6%) and 98.7% (95% : 97.0%-99.5%) for MACE I and 98.7% (95% : 96.8%-99.7%) and 99.0% (95% : 97.4%-99.6%) for MACE II, respectively.

CONCLUSION

EDACS-ADP could help identify patients as safe for early discharge. However, when unstable angina was added to the outcome, the 30-day MACE rate among the designated low-risk patients remained above the level acceptable for early discharge without further evaluation.