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Comparison of early biomarker strategies with the H eart F oundation of A ustralia/ C ardiac S ociety of A ustralia and N ew Z ealand guidelines for risk stratification of emergency department patients with chest pain
Author(s) -
Cullen Louise,
Parsonage William A,
Greenslade Jaimi,
Lamanna Arvin,
Hammett Christopher J,
Than Martin,
Ungerer Jacobus PJ,
Chu Kevin,
O'Kane Shanen,
Brown Anthony FT
Publication year - 2012
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.12008
Subject(s) - medicine , risk stratification , troponin i , troponin t , prospective cohort study , myocardial infarction
Objectives To compare cardiac risk stratification using a 0 and 2 h point‐of‐care ( POC ) cardiac troponin (c T n), 0 and 2 h POC multi‐biomarkers against the 0 and 6 h laboratory c T n reference standard. Methods A prospective observational study of ED patients presenting with chest pain was performed. Patients were risk stratified and treated as per the H eart F oundation of A ustralia/ C ardiac S ociety of A ustralia and N ew Z ealand ( HF ‐ A / CS‐ANZ ) guidelines using the 0 and 6 h laboratory c T n ( T 6). Patients were further stratified using a 0 and 2 h POC c T n ( T 2) plus 0 and 2 h POC multi‐biomarkers (c T n, creatine kinase‐ MB , myoglobin) ( M 2). The T 6, T 2 and M 2 strategies were compared using the 30‐day major adverse cardiac events as the primary outcome. Results Seven hundred and four patients (median age 54 years, male 62.1%) were enrolled. Using the T 6 reference standard, 2%, 61% and 37% were stratified as low, intermediate and high risk, respectively. The 30‐day event rates were 0%, 3.5% and 28.6%, respectively. The T 2 strategy stratified 1.5%, 57% and 41% as low, intermediate and high risk, respectively, with 30‐day event rates of 0%, 4.2% and 24.8%, respectively. The M 2 strategy resulted in significantly different risk distribution with 1%, 40% and 59% stratified as low, intermediate and high risk, respectively, with 30‐day event rates of 0%, 3.9% and 18.8%, respectively.Conclusion Using a 2 h POC c T n‐only biomarker strategy with the HF ‐ A / CS‐ANZ guidelines accurately identified a population at intermediate risk of 30‐day events in whom further objective testing might be accelerated, allowing subsequent early discharge of the majority of this cohort. Within 2 h of presentation a high risk population could be identified in whom early management, including admission, was required.