Identifying Patients Suitable for Discharge After a Single-Presentation High-Sensitivity Troponin Result: A Comparison of Five Established Risk Scores.

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Presentation transcript:

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 Edward W. Carlton, MBChB, Ahmed Khattab, PhD, Kim Greaves, MD Annals of Emergency Medicine Volume 66, Issue 6, Pages 635-645.e1 (December 2015) DOI: 10.1016/j.annemergmed.2015.07.006 Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure 1 Summary of the clinical variables that make up each risk score and definitions of suitability for discharge according to each score and high-sensitivity troponin assay. m-Goldman, Modified Goldman; hs-cTnT, high-sensitivity troponin T; hs-cTnI, high-sensitivity troponin I; hs-cTn, high-sensitivity troponin. *Risk factors for coronary artery disease: Family history (<65 years) of premature coronary artery disease, hypercholesterolemia, diabetes mellitus, hypertension, or current smoker. †Patient reported coronary intervention or evidence from hospital record. ‡Patients with ST depression were not included within this study cohort. §30 ng/L For hs-cTnT was selected as the upper reference value because of manufacturer (Roche) recommendations. ‖78.6 ng/L Was chosen as the upper reference value for hs-cTnI because there were no manufacturer recommendations and validation studies of the HEART score used an upper cutoff of greater than or equal to 3 times the normal limit.17 Annals of Emergency Medicine 2015 66, 635-645.e1DOI: (10.1016/j.annemergmed.2015.07.006) Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure 2 Recruitment flow chart. AMI, Acute myocardial infarction. Annals of Emergency Medicine 2015 66, 635-645.e1DOI: (10.1016/j.annemergmed.2015.07.006) Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure 3 Test performance of each risk score in combination with presentation high-sensitivity troponin T (A) and high-sensitivity troponin I (B) results as illustrated by sensitivity against specificity. Error bars: 95% CIs. Annals of Emergency Medicine 2015 66, 635-645.e1DOI: (10.1016/j.annemergmed.2015.07.006) Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure 4 Clinical utility of risk scores in combination with presentation high-sensitivity troponin T (A) and high-sensitivity troponin I (B) results. Error bars: 95% CIs. Annals of Emergency Medicine 2015 66, 635-645.e1DOI: (10.1016/j.annemergmed.2015.07.006) Copyright © 2015 American College of Emergency Physicians Terms and Conditions