Comparison of two clinical scoring systems for emergency department risk stratification of suspected acute coronary syndrome
MetadataShow full item record
Objective: To compare two methods of risk stratification for suspected acute coronary syndrome (ACS) in the ED. Methods: A prospective observational multicentre study was undertaken of patients undergoing evaluation in the ED for possible ACS. We compared the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand (NHF/CSANZ) guideline and the Thrombolysis in Myocardial Infarction (TIMI) risk score for differentiating high- and low-risk patients. Composite outcome was all cause death, myocardial infarction or coronary revascularisation within 30 days. Results: Of 1758 enrolments, 223 (13%) reached the study outcome. Area under the receiver operator characteristic (ROC) curve was 0.79 (95% CI 0.76-0.81) for the NHF/CSANZ group and 0.71 (0.68-0.75) for TIMI score based on initial troponin result (P<0.001), and 0.82 (95% CI 0.80-0.84) and 0.76 (0.73-0.79) respectively when the 8-12h troponin result is included (P=0.001). Thirty day event rates were 33% for NHF/CSANZ high-risk vs 1.5% for combined low/intermediate risk (P<0.001). For TIMI score, 30 day event rates were 23% for a score =2 and 4.8% for TIMI<2 (P<0.001). The NHF/CSANZ guideline identified more patients as low risk compared with the TIMI risk score (61% vs 48%, P<0.001). Conclusions: The NHF/CSANZ guideline is superior to the TIMI risk score for risk stratification of suspected ACS in the ED. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Showing items related by title, author, creator and subject.
Validation of high-sensitivity troponin I in a 2-hour diagnostic strategy to assess 30-day outcomes in emergency department patients with possible acute coronary syndromeCullen, L.; Mueller, C.; Parsonage, W.; Wildi, K.; Greenslade, J.; Twerenbold, R.; Aldous, S.; Meller, B.; Tate, J.; Reichlin, T.; Hammett, C.; Zellweger, C.; Ungerer, J.; Rubini Gimenez, M.; Troughton, R.; Murray, K.; Brown, A.; Mueller, M.; George, P.; Mosimann, T.; Flaws, D.; Reiter, M.; Lamanna, A.; Haaf, P.; Pemberton, C.; Richards, A.; Chu, K.; Reid, Christopher; Peacock, W.; Jaffe, A.; Florkowski, C.; Deely, J.; Than, M. (2013)Objectives The study objective was to validate a new high-sensitivity troponin I (hs-TnI) assay in a clinical protocol for assessing patients who present to the emergency department with chest pain. Background Protocols ...
Comparison of new point-of-care troponin assay with high sensitivity troponin in diagnosing myocardial infarctionAldous, S.; Mark Richards, A.; George, P.; Cullen, L.; Parsonage, W.; Flaws, D.; Florkowski, C.; Troughton, R.; O'Sullivan, J.; Reid, Christopher; Bannister, L.; Than, M. (2014)Objectives: The aim of this study is to compare a new improved point of care cardiac troponin assay (new POC-cTnI) with 1. its predecessor (old POC-cTnI) and 2. a high sensitivity assay (hs-cTnI) for the diagnosis of acute ...
Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patientsMeller, B.; Cullen, L.; Parsonage, W.; Greenslade, J.; Aldous, S.; Reichlin, T.; Wildi, K.; Twerenbold, R.; Jaeger, C.; Hillinger, P.; Haaf, P.; Puelacher, C.; Kern, V.; Rentsch, K.; Stallone, F.; Gimenez, M.; Ballarino, P.; Bassetti, S.; Walukiewicz, A.; Troughton, R.; Pemberton, C.; Richards, M.; Chu, Chuan-Wei; Reid, Christopher; Than, M.; Mueller, C. (2015)Background: We aimed to evaluate the efficacy and safety of using high-sensitivity cardiac troponin T (hs-cTnT) within an accelerated diagnostic protocol (ADP) in patients presenting with symptoms suggestive of acute ...