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
Martin ThanA Mark Richards

Abstract

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). 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. 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. 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 invest...Continue Reading

References

Oct 26, 1999·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·J E Hollander
Aug 11, 2000·JAMA : the Journal of the American Medical Association·E M AntmanE Braunwald
Dec 4, 2004·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Judd E HollanderUNKNOWN Multidisciplinary Standardized Reporting Criteria Task Force
Jan 20, 2005·Heart·S GoodacreJ Nicholl
Nov 27, 2007·Journal of the American College of Cardiology·Kristian ThygesenUNKNOWN Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction
May 8, 2008·European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine·Hector Alonso ValleLuis Iglesias Oliva
Nov 15, 2008·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Steven L BernsteinUNKNOWN Society for Academic Emergency Medicine, Emergency Department Crowding Task Force
Jun 27, 2009·Journal of the American College of Cardiology·Tobias ReichlinChristian Mueller
Jul 28, 2010·Circulation·Ezra A AmsterdamUNKNOWN American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology,
Sep 17, 2011·Journal of the American College of Cardiology·Richard BodyKevin Mackway-Jones

❮ Previous
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Citations

Nov 10, 2012·Emergency Medicine Journal : EMJ·Ryan Patrick Radecki
Dec 21, 2013·European Heart Journal·Christian Mueller
Mar 4, 2014·Current Cardiology Reports·Lori B Daniels
Dec 11, 2013·Heart, Lung & Circulation·Louise CullenWilliam A Parsonage
Jun 24, 2014·The American Journal of Emergency Medicine·Christopher W BaughDaniel J Pallin
May 23, 2012·Heart, Lung & Circulation·William A ParsonageMartin Than
Feb 13, 2015·Critical Care : the Official Journal of the Critical Care Forum·Kevin D Rooney, Ulf Martin Schilling
Mar 30, 2016·Biomarkers in Medicine·Johannes Tobias NeumannDirk Westermann
Jan 31, 2015·International Journal of Emergency Medicine·Anne-Maree Kelly, Sharon Klim
Jul 14, 2014·Emergency Medicine Journal : EMJ·Richard BodyPhilip S Lewis
Nov 15, 2014·Critical Reviews in Clinical Laboratory Sciences·Peter E HickmanJulia M Potter
Dec 25, 2015·American Heart Journal·Cedric JaegerChristian Mueller
Oct 25, 2014·Biomarkers in Medicine·Frederick K Korley, Allan S Jaffe
Nov 7, 2015·European Heart Journal·Fabrizio MontecuccoThomas H Schindler
Sep 19, 2014·The American Journal of Medicine·Jaskanwal D S SaraAllan S Jaffe
Aug 19, 2014·The Canadian Journal of Cardiology·Justin A EzekowitzPaul W Armstrong
May 15, 2016·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Richard BodyUNKNOWN TRAPID-AMI Investigators
Sep 18, 2016·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Matthew C DeLaneyJared J Thomas
Nov 12, 2013·The American Journal of Emergency Medicine·Olan A SoremekunJudd E Hollander
Aug 2, 2016·Heart, Lung & Circulation·Derek P ChewUNKNOWN NHFA/CSANZ ACS Guideline 2016 Executive Working Group:
May 25, 2013·The American Journal of Emergency Medicine·Jaimi H GreensladeWilliam A Parsonage
Apr 7, 2017·Nature Reviews. Cardiology·Dirk WestermannStefan Blankenberg
Apr 22, 2017·European Heart Journal. Acute Cardiovascular Care·Ezra A Amsterdam, Sandhya Venugopal
Apr 25, 2017·The Western Journal of Emergency Medicine·Maite Anna Huis In 't VeldAmal Mattu
May 2, 2017·Critical Reviews in Clinical Laboratory Sciences·Marek KozinskiGrazyna Sypniewska
May 17, 2017·Critical Pathways in Cardiology·Joseph BoveStephen Artim
Mar 7, 2017·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Maame Yaa A B YiadomUNKNOWN ED Operations Study Group 2015
Jan 15, 2014·Expert Review of Cardiovascular Therapy·Michael K CheezumRon Blankstein
Nov 26, 2016·Journal of the American College of Cardiology·John E BrushHarlan M Krumholz
Nov 1, 2016·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Thomas KnowlmanLouise Cullen
Jun 26, 2017·The American Journal of Medicine·Kai M EggersBertil Lindahl
Jun 14, 2017·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Jaimi Greenslade, Louise Cullen

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