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ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2018, Number 1

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An Med Asoc Med Hosp ABC 2018; 63 (1)

PRETEST risk score and ultrasensitive troponin I used in a chest pain unit in the emergency room. A new approach with an old tool

Pérez CJA, Mérigo AC, Montoya GC, Hernández FKS

Language: Spanish
References: 22
Page: 14-19
PDF size: 223.55 Kb.


ABSTRACT

Introduction: Chest pain units are a useful tool in emergency rooms, their main goal is a quick admission and evaluation of patients with chest pain. PRETEST risk scores are clinical evaluation methods used to detect patients with low risk of developing an acute coronary syndrome. Objectives: To determine the effectiveness of the PRETEST risk score to rule out patients with a low risk of having an acute coronary syndrome. Material and methods: Chest pain patients were evaluated in the emergency room of the ABC Medical Center (CMABC); basic clinical data like age, gender and type of pain was obtained. Using the «chest pain unit» protocol, the PRETEST risk score was calculated along with the troponin I measurement. The TIMSA/ONBASE system was consulted to corroborate the diagnosis. Sensitivity, specificity, positive predictive value, negative predictive value and odds ratio (OR) were calculated and analyzed. Results: One hundred fourteen patients were recruited, 75.4% male and 24.6% female. Typical chest pain was found in 21.9% of the patients. The PRETEST risk score had a sensitivity of 38%, a 93.8% specificity, a positive predictive value of 82.6% and a negative predictive value of 65.9% (p ‹ 0.05). The PRETEST plus troponin I reached a specificity of 100% (p ‹ 0.05). Conclusions: The PRETEST risk score plus troponin I represents an advantage in ruling out patients with chest pain and acute coronary syndromes.


REFERENCES

  1. Kontos MC, Diercks DB, Kirk JD. Emergency department and office-based evaluation of patients with chest pain. Mayo Clin Proc. 2010; 85 (3): 284-299.

  2. Ayerbe L, González E, Gallo V, Coleman CL, Wragg A, Robson J. Clinical assessment of patients with chest pain; a systematic review of predictive tools. BMC Cardiovasc Disord. 2016; 16: 18.

  3. Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation. 1999; 99 (21): 2829-2848.

  4. Wolk MJ, Bailey SR, Doherty JU, Douglas PS, Hendel RC, Kramer CM et al. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014; 63 (4): 380-406.

  5. Wechkunanukul K, Grantham H, Clark RA. Global review of delay time in seeking medical care for chest pain: an integrative literature review. Aust Crit Care. 2017; 30 (1): 13-20.

  6. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD et al. Third universal definition of myocardial infarction. Circulation. 2012; 126 (16): 2020-2035.

  7. Smulders MW, Kietselaer BL, Schalla S, Bucerius J, Jaarsma C, van Dieijen-Visser MP et al. Acute chest pain in the high-sensitivity cardiac troponin era: A changing role for noninvasive imaging? Am Heart J. 2016; 177: 102-111.

  8. Storrow AB, Christenson RH, Nowak RM, Diercks DB, Singer AJ, Wu AH et al. Diagnostic performance of cardiac troponin I for early rule-in and rule-out of acute myocardial infarction: Results of a prospective multicenter trial. Clin Biochem. 2015; 48 (4-5): 254-259.

  9. Eggers KM, Johnston N, James S, Lindahl B, Venge P. Cardiac troponin I levels in patients with non-ST-elevation acute coronary syndrome —the importance of gender. Am Heart J. 2014; 168 (3): 317-324.e1.

  10. Korley FK, Schulman SP, Sokoll LJ, DeFilippis AP, Stolbach AI, Bayram JD et al. Troponin elevations only detected with a high-sensitivity assay: clinical correlations and prognostic significance. Acad Emerg Med. 2014; 21 (7): 727-735.

  11. Bittencourt MS, Hulten E, Polonsky TS, Hoffman U, Nasir K, Abbara S et al. European Society of Cardiology —Recommended Coronary Artery Disease Consortium Pretest Probability Scores more accurately predict obstructive coronary disease and cardiovascular events than the Diamond and Forrester Score: The Partners Registry. Circulation. 2016; 134 (3): 201-211.

  12. Demarco DC, Papachristidis A, Roper D, Tsironis I, Byrne J, Alfakih K et al. Pre-test probability risk scores and their use in contemporary management of patients with chest pain: One year stress echo cohort study. JRSM Open. 2015; 6 (11): 2054270415611295.

  13. Bassan R. Chest pain units: a modern way of managing patients with chest pain in the emergency department. Arq Bras Cardiol. 2002; 79 (2): 196-209.

  14. Quin G. Chest pain evaluation units. J Accid Emerg Med. 2000; 17 (4): 237-240.

  15. Than M, Cullen L, Aldous S, Parsonage WA, Reid CM, Greenslade J et al. 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol. 2012; 59 (23): 2091-2098.

  16. Cullen L, Mueller C, Parsonage WA, Wildi K, Greenslade JH, Twerenbold R et al. Validation of high-sensitivity troponin I in a 2-hour diagnostic strategy to assess 30-day outcomes in emergency department patients with possible acute coronary syndrome. J Am Coll Cardiol. 2013; 62 (14): 1242-1249.

  17. Reichlin T, Cullen L, Parsonage WA, Greenslade J, Twerenbold R, Moehring B et al. Two-hour algorithm for triage toward rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Am J Med. 2015; 128 (4): 369-379.e4.

  18. Eggers KM, Aldous S, Greenslade JH, Johnston N, Lindahl B, Parsonage WA et al. Two-hour diagnostic algorithms for early assessment of patients with acute chest pain —Implications of lowering the cardiac troponin I cut-off to the 97.5th percentile. Clin Chim Acta. 2015; 445: 19-24.

  19. Boeddinghaus J, Reichlin T, Cullen L, Greenslade JH, Parsonage WA, Hammett C et al. Two-hour algorithm for triage toward rule-out and rule-in of acute myocardial infarction by use of high-sensitivity cardiac troponin I. Clin Chem. 2016; 62 (3): 494-504.

  20. Carlton EW, Khattab A, Greaves K. Identifying patients suitable for discharge after a single-presentation high-sensitivity troponin result: a comparison of five established risk scores and two high-sensitivity assays. Ann Emerg Med. 2015; 66 (6): 635-645.e1.

  21. Herren KR, Mackway-Jones K. Emergency management of cardiac chest pain: a review. Emerg Med J. 2001; 18 (1): 6-10.

  22. Borrás-Pérez FX. Diagnóstico y estratificación de la angina estable. Rev Esp Cardiol Supl. 2012; 12: 9-14.




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