Dataset Information

Using the clinical chemistry score in the emergency department to detect adverse cardiac events: a diagnostic accuracy study.

ABSTRACT:

Background

The ability to rule out or in a major adverse cardiac event (MACE) in patients with suspected acute coronary syndrome at emergency department (ED) presentation would be beneficial to patient care and the health care system. The clinical chemistry score (CCS) was evaluated in this context.

Methods

This diagnostic accuracy study evaluated 2 different ED cohorts with suspected acute coronary syndrome. For patients in cohort 1, who presented to the ED of 3 hospitals in Hamilton, Ontario, between May and August 2013, retrospective measurements were taken using the Ortho Clinical Diagnostics high-sensitivity cardiac troponin I (hs-cTnI) assay; for patients in cohort 2, who presented to the ED of the same 3 hospitals in Hamilton between November 2012 and February 2013, an ED cardiac presentation blood test panel was performed with the Abbott Diagnostics hs-cTnI assay. The sensitivity and specificity of the CCS (cut-offs of ? 1 and 5) and hs-cTnI alone (published cut-offs) were compared for MACE (composite of death, myocardial infarction, unstable angina, revascularization) at 30 days for both cohorts and at 90 days for cohort 2.

Results

The incidence of MACE at 30 days was higher in cohort 1 (n = 1058) (19.4%, 95% confidence interval [CI] 16.8%-22.2%) than in cohort 2 (n = 5974) (14.6%, 95% CI 13.6%-15.6%). In cohort 1, a CCS of 1 or above yielded a sensitivity of 99.5% (95% CI 97.3%-99.9%). The sensitivity with an Ortho hs-cTnI cut-off of 1 ng/L or above was 91.2% (95% CI 86.5%-95.7%). The specificity of a CCS of 5 (97.8%, 95% CI 96.5%-98.7%) was higher than when the overall 99th-percentile cut-off for the Ortho hs-cTnI assay (> 11 ng/L; 90.1%, 95% CI 87.9%-92.0%) was used. A similar pattern was observed in cohort 2 at 30 days and persisted at 90 days with the Abbott hs-cTnI assay.

Interpretation

The CCS derived with 2 different hs-cTnI assays and ED populations yielded higher sensitivity and specificity estimates for MACE than hs-cTnI alone. An intervention study is needed to evaluate the impact of the CCS at both the patient and hospital levels.

Trial registration

ClinicalTrials.gov, no. NCT01994577.

SUBMITTER: Kavsak PA

PROVIDER: S-EPMC7608943 | biostudies-literature | 2020 Oct-Dec

REPOSITORIES: biostudies-literature

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Publications

Using the clinical chemistry score in the emergency department to detect adverse cardiac events: a diagnostic accuracy study.

Kavsak Peter A PA Cerasuolo Joshua O JO Ko Dennis T DT Ma Jinhui J Sherbino Jonathan J Mondoux Shawn E SE Clayton Natasha N Hill Stephen A SA McQueen Matthew M Griffith Lauren E LE Mehta Shamir R SR Perez Richard R Seow Hsien H Devereaux P J PJ Worster Andrew A

CMAJ open 20201001 4

<h4>Background</h4>The ability to rule out or in a major adverse cardiac event (MACE) in patients with suspected acute coronary syndrome at emergency department (ED) presentation would be beneficial to patient care and the health care system. The clinical chemistry score (CCS) was evaluated in this context.<h4>Methods</h4>This diagnostic accuracy study evaluated 2 different ED cohorts with suspected acute coronary syndrome. For patients in cohort 1, who presented to the ED of 3 hospitals in Hami ...[more]

PMID: 33139388

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Dataset Information

Using the clinical chemistry score in the emergency department to detect adverse cardiac events: a diagnostic accuracy study.

Background

Methods

Results

Interpretation

Trial registration

Publications

Using the clinical chemistry score in the emergency department to detect adverse cardiac events: a diagnostic accuracy study.

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