Pickering JW, et al. - Researchers tested if the Emergency Department Assessment of Chest Pain Score (EDACS) combined with a single measurement of high-sensitivity cardiac troponin (hs-cTn) could allow early discharge of a clinically meaningful proportion of patients. They identified over 30% of patients as low risk with single measurements of both hs-cTnI and hs-cTnT at presentation combined with EDACS. These patients were, therefore, eligible for safe early discharge after only one blood draw.

Methods

• From 4 patient cohorts from New Zealand and Australia presenting to an Emergency Department with symptoms suggestive of ACS, data was retrieved.
• Major adverse cardiac events (MACE) within 30 days of presentation was the primary outcome measure.
• The sensitivity for MACE and percentage low risk of every combination of high-sensitivity cardiac troponin T (hs-cTnT) concentration and high-sensitivity cardiac troponin I (hs-cTnI) concentration with EDACS was assessed in patients with a nonischemic ECG.
• A standard smoothing technique on the probability density function was used for hs-cTn and EDACS and bootstrapping was applied to determine the optimal threshold combinations, namely, the combination that maximized the percentage low risk with ≥ 98.5% sensitivity for MACE.

Results

• In total 2,258 of 2,536 patients presented without an ischemic ECG; 272/2,258 (12.1%) had a MACE within 30 days.
• Researchers noted that the optimal threshold for hs-cTnI was 7 ng/L combined with an EDACS threshold of 16 (36.8% patients low risk).
• For hs-cTnT, the optimal thresholds were 8 ng/L combined with an EDACS threshold of 15 (30.2% patients low risk).