RT Journal Article
SR Electronic
T1 Using the clinical chemistry score in the emergency department to detect adverse cardiac events: a diagnostic accuracy study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E676
OP E684
DO 10.9778/cmajo.20200047
VO 8
IS 4
A1 Peter A. Kavsak
A1 Joshua O. Cerasuolo
A1 Dennis T. Ko
A1 Jinhui Ma
A1 Jonathan Sherbino
A1 Shawn E. Mondoux
A1 Natasha Clayton
A1 Stephen A. Hill
A1 Matthew McQueen
A1 Lauren E. Griffith
A1 Shamir R. Mehta
A1 Richard Perez
A1 Hsien Seow
A1 P.J. Devereaux
A1 Andrew Worster
YR 2020
UL http://www.cmajopen.ca/content/8/4/E676.abstract
AB Background: The ability to rule out or in a major adverse cardiac event (MACE) in patients with suspected acute coronary syndrome at emergency department (ED) presentation would be beneficial to patient care and the health care system. The clinical chemistry score (CCS) was evaluated in this context.Methods: This diagnostic accuracy study evaluated 2 different ED cohorts with suspected acute coronary syndrome. For patients in cohort 1, who presented to the ED of 3 hospitals in Hamilton, Ontario, between May and August 2013, retrospective measurements were taken using the Ortho Clinical Diagnostics high-sensitivity cardiac troponin I (hs-cTnI) assay; for patients in cohort 2, who presented to the ED of the same 3 hospitals in Hamilton between November 2012 and February 2013, an ED cardiac presentation blood test panel was performed with the Abbott Diagnostics hs-cTnI assay. The sensitivity and specificity of the CCS (cut-offs of ≥ 1 and 5) and hs-cTnI alone (published cut-offs) were compared for MACE (composite of death, myocardial infarction, unstable angina, revascularization) at 30 days for both cohorts and at 90 days for cohort 2.Results: The incidence of MACE at 30 days was higher in cohort 1 (n = 1058) (19.4%, 95% confidence interval [CI] 16.8%–22.2%) than in cohort 2 (n = 5974) (14.6%, 95% CI 13.6%–15.6%). In cohort 1, a CCS of 1 or above yielded a sensitivity of 99.5% (95% CI 97.3%–99.9%). The sensitivity with an Ortho hs-cTnI cut-off of 1 ng/L or above was 91.2% (95% CI 86.5%–95.7%). The specificity of a CCS of 5 (97.8%, 95% CI 96.5%–98.7%) was higher than when the overall 99th-percentile cut-off for the Ortho hs-cTnI assay (> 11 ng/L; 90.1%, 95% CI 87.9%–92.0%) was used. A similar pattern was observed in cohort 2 at 30 days and persisted at 90 days with the Abbott hs-cTnI assay.Interpretation: The CCS derived with 2 different hs-cTnI assays and ED populations yielded higher sensitivity and specificity estimates for MACE than hs-cTnI alone. An intervention study is needed to evaluate the impact of the CCS at both the patient and hospital levels. Trial registration: ClinicalTrials.gov, no. NCT01994577