Performance of the EDACS-accelerated Diagnostic Pathway in a Cohort of US Patients with Acute Chest Pain.

Abstract

BACKGROUND:

The Emergency Department Assessment of Chest pain Score-Accelerated Diagnostic Protocol (EDACS-ADP) is a decision aid designed to safely identify emergency department (ED) patients with chest pain for early discharge. Derivation and validation studies in Australasia have demonstrated high sensitivity (99%-100%) for major adverse cardiac events (MACE).

OBJECTIVES:

To validate the EDACS-ADP in a cohort of US ED patients with symptoms suspicious for acute coronary syndrome (ACS).

METHODS:

A secondary analysis of participants enrolled in the HEART Pathway Randomized Controlled Trial was conducted. This single-site trial enrolled 282 ED patients≥21 years old with symptoms concerning for ACS, inclusive of all cardiac risk levels. Each patient was classified as low risk or at risk by the EDACS-ADP based on EDACS, electrocardiogram, and serial troponins. Potential early discharge rate and sensitivity for MACE at 30 days, defined as cardiac death, myocardial infarction (MI), or coronary revascularization were calculated.

RESULTS:

MACE occurred in 17/282 (6.0%) participants, including no deaths, 16/282 (5.6%) with MI, and 1/282 (0.4%) with coronary revascularization without MI. The EDACS-ADP identified 188/282 patients [66.7%, 95% confidence interval (CI): 60.8%-72.1%] as low risk. Of these, 2/188 (1.1%, 95% CI: 0.1%-3.9%) had MACE at 30 days. EDACS-ADP was 88.2% (95% CI: 63.6%-98.5%) sensitive for MACE, identifying 15/17 patients. Of the 2 patients identified as low risk with MACE, 1 had MI and 1 had coronary revascularization without MI.

CONCLUSIONS:

Within a US cohort of ED patients with symptoms concerning for ACS, sensitivity for MACE was 88.2%. We are unable to validate the EDACS-ADP as sufficiently sensitive for clinical use.

• Authors: Jason P Stopyra, Chadwick D Miller, Brian C Hiestand, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, Robert F Riley, Gregory B Russell, James W Hoekstra, Simon A Mahler
• Journal: Critical pathways in cardiology (Crit Pathw Cardiol) Vol. 14 Issue 4 Pg. 134-8 (Dec 2015) ISSN: 1535-2811 [Electronic] United States
• PMID: 26569652 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Troponin

Topics

• Acute Coronary Syndrome (blood, complications, diagnosis)
• Adult
• Aged
• Chest Pain (blood, diagnosis, etiology)
• Cohort Studies
• Critical Pathways
• Death
• Decision Support Techniques
• Electrocardiography
• Emergency Service, Hospital
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (blood, epidemiology)
• Myocardial Revascularization (statistics & numerical data)
• Troponin (blood)
• United States (epidemiology)