100% sensitivity with two accelerated diagnostic pathways for ruling out acute myocardial infarction

Study shows 100% sensitivity for two accelerated diagnostic pathways

In a study of 1,811 patients who presented to the emergency department (ED), high-sensitivity troponin I was measured with presentation and 2-hour blood samples to find the accuracy and performance of five accelerated chest pain pathways calculated with the Access hsTnI (High Sensitivity Troponin I) Assay. Patients were then classified as being low risk according to five rules: modified accelerated diagnostic protocol to assess patients with chest pain symptoms using troponin as the only biomarker (m-ADAPT); the Emergency Department Assessment of Chest Pain Score (EDACS) pathway; the History, ECG, Age, Risk Factors, and Troponin (HEART) pathway; the No Objective Testing Rule; and the new Vancouver Chest Pain Rule. Endpoints were 30-day acute myocardial infarction and acute coronary syndrome. Measures of diagnostic accuracy for each rule were calculated.

The study concluded:

  • The new Vancouver Chest Pain Rule and No Objective Testing Rule had high sensitivity for acute myocardial infarction (100% for both) and acute coronary syndrome (98.6% and 99.3%)
  • The m-ADAPT, EDACS, and HEART pathways also yielded high sensitivity for acute myocardial infarction (96.9% for m-ADAPT and 95% for EDACS and HEART)
  • Using the Access hsTnI Assay with the new Vancouver Chest Pain Rule or No Objective Testing Rule enabled approximately one third of patients to be safely discharged after 2-hour risk stratification with no further testing
  • The EDACS, m-ADAPT, or HEART pathway enabled half of ED patients to be rapidly referred for objective testing

At a Glance

Patients who presented to an ED in Australia
1 /2
Of ED patients able to be rapidly referred for objective testing with the EDACS, m-ADAPT or HEART pathway
100 %
Sensitivity for acute myocardial infarction using the new Vancouver Chest Pain Rule or the No Objective Testing Rule

Source: Greenslade, J. H., Carlton, E. W., Van Hise, C., Cho, E., Hawkins, T., Parsonage, W. A., Tate, J., Ungerer, J., & Cullen, L. (2018). Diagnostic Accuracy of a New High-Sensitivity Troponin I Assay and Five Accelerated Diagnostic Pathways for Ruling Out Acute Myocardial Infarction and Acute Coronary Syndrome. Annals of Emergency Medicine, 71(4), 439–451.e3. https://doi.org/10.1016/j.annemergmed.2017.10.030