2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: The ADAPT trial

Martin Than, Louise Cullen, Sally Aldous, William A. Parsonage, Christopher M. Reid, Jaimi Greenslade, Dylan Flaws, Christopher J. Hammett, Daren Beam, Michael W. Ardagh, Richard Troughton, Anthony F T Brown, Peter George, Christopher M. Florkowski, Jeffrey Kline, W. Frank Peacock, Alan S. Maisel, Swee Han Lim, Arvin Lamanna, A. Mark Richards

Research output: Contribution to journalArticle

258 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to determine whether a new accelerated diagnostic protocol (ADP) for possible cardiac chest pain could identify low-risk patients suitable for early discharge (with follow-up shortly after discharge). Background: Patients presenting with possible acute coronary syndrome (ACS), who have a low short-term risk of adverse cardiac events may be suitable for early discharge and shorter hospital stays. Methods: This prospective observational study tested an ADP that included pre-test probability scoring by the Thrombolysis In Myocardial Infarction (TIMI) score, electrocardiography, and 0 + 2 h values of laboratory troponin I as the sole biomarker. Patients presenting with chest pain due to suspected ACS were included. The primary endpoint was major adverse cardiac event (MACE) within 30 days. Results: Of 1,975 patients, 302 (15.3%) had a MACE. The ADP classified 392 patients (20%) as low risk. One (0.25%) of these patients had a MACE, giving the ADP a sensitivity of 99.7% (95% confidence interval [CI]: 98.1% to 99.9%), negative predictive value of 99.7% (95% CI: 98.6% to 100.0%), specificity of 23.4% (95% CI: 21.4% to 25.4%), and positive predictive value of 19.0% (95% CI: 17.2% to 21.0%). Many ADP negative patients had further investigations (74.1%), and therapeutic (18.3%) or procedural (2.0%) interventions during the initial hospital attendance and/or 30-day follow-up. Conclusions: Using the ADP, a large group of patients was successfully identified as at low short-term risk of a MACE and therefore suitable for rapid discharge from the emergency department with early follow-up. This approach could decrease the observation period required for some patients with chest pain. (An observational study of the diagnostic utility of an accelerated diagnostic protocol using contemporary central laboratory cardiac troponin in the assessment of patients presenting to two Australasian hospitals with chest pain of possible cardiac origin; ACTRN12611001069943)

Original languageEnglish (US)
Pages (from-to)2091-2098
Number of pages8
JournalJournal of the American College of Cardiology
Volume59
Issue number23
DOIs
StatePublished - Jun 5 2012
Externally publishedYes

Fingerprint

Troponin
Chest Pain
Biomarkers
Confidence Intervals
Acute Coronary Syndrome
Observational Studies
Troponin I
Hospital Emergency Service
Length of Stay
Electrocardiography
Myocardial Infarction
Observation
Prospective Studies

Keywords

  • acute coronary syndromes
  • acute myocardial infarction
  • emergency department
  • sensitivity and specificity
  • troponins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker : The ADAPT trial. / Than, Martin; Cullen, Louise; Aldous, Sally; Parsonage, William A.; Reid, Christopher M.; Greenslade, Jaimi; Flaws, Dylan; Hammett, Christopher J.; Beam, Daren; Ardagh, Michael W.; Troughton, Richard; Brown, Anthony F T; George, Peter; Florkowski, Christopher M.; Kline, Jeffrey; Peacock, W. Frank; Maisel, Alan S.; Lim, Swee Han; Lamanna, Arvin; Richards, A. Mark.

In: Journal of the American College of Cardiology, Vol. 59, No. 23, 05.06.2012, p. 2091-2098.

Research output: Contribution to journalArticle

Than, M, Cullen, L, Aldous, S, Parsonage, WA, Reid, CM, Greenslade, J, Flaws, D, Hammett, CJ, Beam, D, Ardagh, MW, Troughton, R, Brown, AFT, George, P, Florkowski, CM, Kline, J, Peacock, WF, Maisel, AS, Lim, SH, Lamanna, A & Richards, AM 2012, '2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: The ADAPT trial', Journal of the American College of Cardiology, vol. 59, no. 23, pp. 2091-2098. https://doi.org/10.1016/j.jacc.2012.02.035
Than, Martin ; Cullen, Louise ; Aldous, Sally ; Parsonage, William A. ; Reid, Christopher M. ; Greenslade, Jaimi ; Flaws, Dylan ; Hammett, Christopher J. ; Beam, Daren ; Ardagh, Michael W. ; Troughton, Richard ; Brown, Anthony F T ; George, Peter ; Florkowski, Christopher M. ; Kline, Jeffrey ; Peacock, W. Frank ; Maisel, Alan S. ; Lim, Swee Han ; Lamanna, Arvin ; Richards, A. Mark. / 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker : The ADAPT trial. In: Journal of the American College of Cardiology. 2012 ; Vol. 59, No. 23. pp. 2091-2098.
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abstract = "Objectives: The purpose of this study was to determine whether a new accelerated diagnostic protocol (ADP) for possible cardiac chest pain could identify low-risk patients suitable for early discharge (with follow-up shortly after discharge). Background: Patients presenting with possible acute coronary syndrome (ACS), who have a low short-term risk of adverse cardiac events may be suitable for early discharge and shorter hospital stays. Methods: This prospective observational study tested an ADP that included pre-test probability scoring by the Thrombolysis In Myocardial Infarction (TIMI) score, electrocardiography, and 0 + 2 h values of laboratory troponin I as the sole biomarker. Patients presenting with chest pain due to suspected ACS were included. The primary endpoint was major adverse cardiac event (MACE) within 30 days. Results: Of 1,975 patients, 302 (15.3{\%}) had a MACE. The ADP classified 392 patients (20{\%}) as low risk. One (0.25{\%}) of these patients had a MACE, giving the ADP a sensitivity of 99.7{\%} (95{\%} confidence interval [CI]: 98.1{\%} to 99.9{\%}), negative predictive value of 99.7{\%} (95{\%} CI: 98.6{\%} to 100.0{\%}), specificity of 23.4{\%} (95{\%} CI: 21.4{\%} to 25.4{\%}), and positive predictive value of 19.0{\%} (95{\%} CI: 17.2{\%} to 21.0{\%}). Many ADP negative patients had further investigations (74.1{\%}), and therapeutic (18.3{\%}) or procedural (2.0{\%}) interventions during the initial hospital attendance and/or 30-day follow-up. Conclusions: Using the ADP, a large group of patients was successfully identified as at low short-term risk of a MACE and therefore suitable for rapid discharge from the emergency department with early follow-up. This approach could decrease the observation period required for some patients with chest pain. (An observational study of the diagnostic utility of an accelerated diagnostic protocol using contemporary central laboratory cardiac troponin in the assessment of patients presenting to two Australasian hospitals with chest pain of possible cardiac origin; ACTRN12611001069943)",
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TY - JOUR

T1 - 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker

T2 - The ADAPT trial

AU - Than, Martin

AU - Cullen, Louise

AU - Aldous, Sally

AU - Parsonage, William A.

AU - Reid, Christopher M.

AU - Greenslade, Jaimi

AU - Flaws, Dylan

AU - Hammett, Christopher J.

AU - Beam, Daren

AU - Ardagh, Michael W.

AU - Troughton, Richard

AU - Brown, Anthony F T

AU - George, Peter

AU - Florkowski, Christopher M.

AU - Kline, Jeffrey

AU - Peacock, W. Frank

AU - Maisel, Alan S.

AU - Lim, Swee Han

AU - Lamanna, Arvin

AU - Richards, A. Mark

PY - 2012/6/5

Y1 - 2012/6/5

N2 - Objectives: The purpose of this study was to determine whether a new accelerated diagnostic protocol (ADP) for possible cardiac chest pain could identify low-risk patients suitable for early discharge (with follow-up shortly after discharge). Background: Patients presenting with possible acute coronary syndrome (ACS), who have a low short-term risk of adverse cardiac events may be suitable for early discharge and shorter hospital stays. Methods: This prospective observational study tested an ADP that included pre-test probability scoring by the Thrombolysis In Myocardial Infarction (TIMI) score, electrocardiography, and 0 + 2 h values of laboratory troponin I as the sole biomarker. Patients presenting with chest pain due to suspected ACS were included. The primary endpoint was major adverse cardiac event (MACE) within 30 days. Results: Of 1,975 patients, 302 (15.3%) had a MACE. The ADP classified 392 patients (20%) as low risk. One (0.25%) of these patients had a MACE, giving the ADP a sensitivity of 99.7% (95% confidence interval [CI]: 98.1% to 99.9%), negative predictive value of 99.7% (95% CI: 98.6% to 100.0%), specificity of 23.4% (95% CI: 21.4% to 25.4%), and positive predictive value of 19.0% (95% CI: 17.2% to 21.0%). Many ADP negative patients had further investigations (74.1%), and therapeutic (18.3%) or procedural (2.0%) interventions during the initial hospital attendance and/or 30-day follow-up. Conclusions: Using the ADP, a large group of patients was successfully identified as at low short-term risk of a MACE and therefore suitable for rapid discharge from the emergency department with early follow-up. This approach could decrease the observation period required for some patients with chest pain. (An observational study of the diagnostic utility of an accelerated diagnostic protocol using contemporary central laboratory cardiac troponin in the assessment of patients presenting to two Australasian hospitals with chest pain of possible cardiac origin; ACTRN12611001069943)

AB - Objectives: The purpose of this study was to determine whether a new accelerated diagnostic protocol (ADP) for possible cardiac chest pain could identify low-risk patients suitable for early discharge (with follow-up shortly after discharge). Background: Patients presenting with possible acute coronary syndrome (ACS), who have a low short-term risk of adverse cardiac events may be suitable for early discharge and shorter hospital stays. Methods: This prospective observational study tested an ADP that included pre-test probability scoring by the Thrombolysis In Myocardial Infarction (TIMI) score, electrocardiography, and 0 + 2 h values of laboratory troponin I as the sole biomarker. Patients presenting with chest pain due to suspected ACS were included. The primary endpoint was major adverse cardiac event (MACE) within 30 days. Results: Of 1,975 patients, 302 (15.3%) had a MACE. The ADP classified 392 patients (20%) as low risk. One (0.25%) of these patients had a MACE, giving the ADP a sensitivity of 99.7% (95% confidence interval [CI]: 98.1% to 99.9%), negative predictive value of 99.7% (95% CI: 98.6% to 100.0%), specificity of 23.4% (95% CI: 21.4% to 25.4%), and positive predictive value of 19.0% (95% CI: 17.2% to 21.0%). Many ADP negative patients had further investigations (74.1%), and therapeutic (18.3%) or procedural (2.0%) interventions during the initial hospital attendance and/or 30-day follow-up. Conclusions: Using the ADP, a large group of patients was successfully identified as at low short-term risk of a MACE and therefore suitable for rapid discharge from the emergency department with early follow-up. This approach could decrease the observation period required for some patients with chest pain. (An observational study of the diagnostic utility of an accelerated diagnostic protocol using contemporary central laboratory cardiac troponin in the assessment of patients presenting to two Australasian hospitals with chest pain of possible cardiac origin; ACTRN12611001069943)

KW - acute coronary syndromes

KW - acute myocardial infarction

KW - emergency department

KW - sensitivity and specificity

KW - troponins

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