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    A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): A prospective observational validation study

    Access Status
    Fulltext not available
    Authors
    Than, M.
    Cullen, L.
    Reid, Christopher
    Lim, S.
    Aldous, S.
    Ardagh, M.
    Peacock, W.
    Parsonage, W.
    Ho, H.
    Ko, H.
    Kasliwal, R.
    Bansal, M.
    Soerianata, S.
    Hu, D.
    Ding, R.
    Hua, Q.
    Seok-Min, K.
    Sritara, P.
    Sae-Lee, R.
    Chiu, T.
    Tsai, K.
    Chu, F.
    Chen, W.
    Chang, W.
    Flaws, D.
    George, P.
    Richards, A.
    Date
    2011
    Type
    Journal Article
    
    Metadata
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    Citation
    Than, M. and Cullen, L. and Reid, C. and Lim, S. and Aldous, S. and Ardagh, M. and Peacock, W. et al. 2011. A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): A prospective observational validation study. The Lancet. 377 (9771): pp. 1077-1084.
    Source Title
    The Lancet
    DOI
    10.1016/S0140-6736(11)60310-3
    ISSN
    0140-6736
    School
    Department of Health Policy and Management
    URI
    http://hdl.handle.net/20.500.11937/16203
    Collection
    • Curtin Research Publications
    Abstract

    Background: Patients with chest pain contribute substantially to emergency department attendances, lengthy hospital stay, and inpatient admissions. A reliable, reproducible, and fast process to identify patients presenting with chest pain who have a low short-term risk of a major adverse cardiac event is needed to facilitate early discharge. We aimed to prospectively validate the safety of a predefined 2-h accelerated diagnostic protocol (ADP) to assess patients presenting to the emergency department with chest pain symptoms suggestive of acute coronary syndrome. Methods: This observational study was undertaken in 14 emergency departments in nine countries in the Asia-Pacific region, in patients aged 18 years and older with at least 5 min of chest pain. The ADP included use of a structured pre-test probability scoring method (Thrombolysis in Myocardial Infarction [TIMI] score), electrocardiograph, and point-of-care biomarker panel of troponin, creatine kinase MB, and myoglobin. The primary endpoint was major adverse cardiac events within 30 days after initial presentation (including initial hospital attendance). This trial is registered with the Australia-New Zealand Clinical Trials Registry, number ACTRN12609000283279. Findings: 3582 consecutive patients were recruited and completed 30-day follow-up. 421 (11·8%) patients had a major adverse cardiac event. The ADP classified 352 (9·8%) patients as low risk and potentially suitable for early discharge. A major adverse cardiac event occurred in three (0·9%) of these patients, giving the ADP a sensitivity of 99·3% (95% CI 97·9–99·8), a negative predictive value of 99·1% (97·3–99·8), and a specificity of 11·0% (10·0–12·2).

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