Risk Stratification of Chest Pain in the Emergency Department: Incorporating a High-Sensitivity Troponin Assay Into Existing Risk Tools
Gibbs J, Peacock WF, Mahler S, Nowak R, DeFilippi C, Christenson R, Apple F, Jacobsen G, and McCord J. RISK STRATIFICATION OF CHEST PAIN IN THE EMERGENCY DEPARTMENT: INCORPORATING A HIGH-SENSITIVITY TROPONIN ASSAY INTO EXISTING RISK TOOLS. J Am Coll Cardiol 2019; 73(9 Suppl 1):202.
J Am Coll Cardiol
Background: Risk scores such as Thrombolysis in Myocardial Infarction (TIMI), History, ECG, Age, Risk Factors, and Troponin (HEART) and Simplified Emergency Department Assessment of Chest Pain Score (sEDACS) have been used to evaluate patients with possible acute myocardial infarct (AMI). We studied the prognostic utility of the TIMI, HEART, and sEDACS scores when supplemented with high-sensitivity cardiac troponin-I (hs-cTnI). Methods: The study included 1,924 suspected AMI patients at 29 hospitals in the United States from 2015-2016. Blood samples were drawn at enrollment and 2-3 hours and tested for hs-cTnI on the Atellica IM TNIH Assay (Siemens Diagnostics). Patients were considered low-risk with a TIMI score = 0, HEART ≤ 3, sEDACS ≤ 15 and hs-cTnI < 45 ng/L (99th%) at time 0 and 2-3 hours. Results: Of 1,924 patients, 259 (13.5%) were diagnosed with AMI. At 30 days, there were 6 (0.3%) additional AMIs, 18 (0.9%) deaths, and 205 (10.7%) revascularizations. There were 430 patients (22.3%) with an elevated hs-cTnI during the index visit. All 3 risk scores combined with hs-cTnI identified a low-risk group. Compared to TIMI (10.8%), HEART (31.2 %) and sEDACS (34.1%) scores defined more patients as low-risk. Conclusion: The TIMI, HEART and sEDACS scores all identify a low-risk group of patients when combined with serial hs-cTnI measurements. The HEART and EDACS scores identified more low-risk patients. These patients could be considered for discharge from the Emergency Department without further testing. [Figure presented]
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