Comparison of acute coronary syndrome decision aids in the emergency department

Mehmet Seyfettin Sarıbaş; Atakan Savrun; Ali Aygun; Şeyda Tuba Savrun

Article Details

Comparison of acute coronary syndrome decision aids in the emergency department

Authors:

Mehmet Seyfettin Sarıbaş | Atakan Savrun | Ali Aygun | Şeyda Tuba Savrun

Publisher:

Cukurova University

Main Topics:

Acil Tıp

Journal:

Cukurova Medical Journal Vol.49 Issue 4, pp.1030-1043

Document Type:

Article

Publication Date:

12/2024

Document Language:

English

Document ID (Org No.):

2001329044

pISSN:

2602-3032

Keywords:

Abstract:

 Purpose: This study compared the performance of the Emergency Department Assessment of Chest Pain Score EDACS, History, Electrocardiography, Age, Risk Factors, Troponin HEART, and Thrombolysis in Myocardial Infarction TIMI in identifying low-risk acute coronary syndrome ACS patients and predicting 30-day major adverse cardiac events MACE. Materials and Methods: This prospective study included patients aged 18 years with nontraumatic chest pain evaluated for ACS. HEART, TIMI, EDACS, and EDACS-ADP scores were calculated. MACE, including myocardial infarction, urgent revascularization, or death, was determined via telephone follow-up. Diagnostic performance was assessed using area under the curve AUC analysis. Results: Among 408 patients, 64 15.7 developed MACE. The HEART score had the highest AUC 0.823, followed by TIMI 0.784, EDACS-ADP 0.769, and EDACS 0.716. HEART had the highest sensitivity 90.6 and negative predictive value NPV; 97.2. TIMI, at a 1 cut-off, had sensitivity of 81.3 and NPV of 94.7; reducing the cut-off to 1 increased sensitivity to 96.8 and NPV to 98.8. EDACS showed sensitivity of 56.2 and NPV of 90.3, whereas EDACS-ADP had sensitivity of 82.8 and NPV of 95.7. Conclusion: The HEART score outperformed TIMI, EDACS, and EDACS-ADP in predicting 30-day MACE, with superior sensitivity and NPV. Adjusting the TIMI cut-off enhances diagnostic performance but may increase ED stay. The HEART score is the most reliable tool for identifying low-risk patients with ACS and enabling safe discharge.

 Purpose: This study compared the performance of the Emergency Department Assessment of Chest Pain Score EDACS, History, Electrocardiography, Age, Risk Factors, Troponin HEART, and Thrombolysis in Myocardial Infarction TIMI in identifying low-risk acute coronary syndrome ACS patients and predicting 30-day major adverse cardiac events MACE. Materials and Methods: This prospective study included patients aged 18 years with nontraumatic chest pain evaluated for ACS. HEART, TIMI, EDACS, and EDACS-ADP scores were calculated. MACE, including myocardial infarction, urgent revascularization, or death, was determined via telephone follow-up. Diagnostic performance was assessed using area under the curve AUC analysis. Results: Among 408 patients, 64 15.7 developed MACE. The HEART score had the highest AUC 0.823, followed by TIMI 0.784, EDACS-ADP 0.769, and EDACS 0.716. HEART had the highest sensitivity 90.6 and negative predictive value NPV; 97.2. TIMI, at a 1 cut-off, had sensitivity of 81.3 and NPV of 94.7; reducing the cut-off to 1 increased sensitivity to 96.8 and NPV to 98.8. EDACS showed sensitivity of 56.2 and NPV of 90.3, whereas EDACS-ADP had sensitivity of 82.8 and NPV of 95.7. Conclusion: The HEART score outperformed TIMI, EDACS, and EDACS-ADP in predicting 30-day MACE, with superior sensitivity and NPV. Adjusting the TIMI cut-off enhances diagnostic performance but may increase ED stay. The HEART score is the most reliable tool for identifying low-risk patients with ACS and enabling safe discharge.

 Purpose: This study compared the performance of the Emergency Department Assessment of Chest Pain Score EDACS, History, Electrocardiography, Age, Risk Factors, Troponin HEART, and Thrombolysis in Myocardial Infarction TIMI in identifying low-risk acute coronary syndrome ACS patients and predicting 30-day major adverse cardiac events MACE. Materials and Methods: This prospective study included patients aged 18 years with nontraumatic chest pain evaluated for ACS. HEART, TIMI, EDACS, and EDACS-ADP scores were calculated. MACE, including myocardial infarction, urgent revascularization, or death, was determined via telephone follow-up. Diagnostic performance was assessed using area under the curve AUC analysis. Results: Among 408 patients, 64 15.7 developed MACE. The HEART score had the highest AUC 0.823, followed by TIMI 0.784, EDACS-ADP 0.769, and EDACS 0.716. HEART had the highest sensitivity 90.6 and negative predictive value NPV; 97.2. TIMI, at a 1 cut-off, had sensitivity of 81.3 and NPV of 94.7; reducing the cut-off to 1 increased sensitivity to 96.8 and NPV to 98.8. EDACS showed sensitivity of 56.2 and NPV of 90.3, whereas EDACS-ADP had sensitivity of 82.8 and NPV of 95.7. Conclusion: The HEART score outperformed TIMI, EDACS, and EDACS-ADP in predicting 30-day MACE, with superior sensitivity and NPV. Adjusting the TIMI cut-off enhances diagnostic performance but may increase ED stay. The HEART score is the most reliable tool for identifying low-risk patients with ACS and enabling safe discharge.

 Amaç: Bu çalışma, Emergency Department Assessment of Chest Pain Score EDACS, History, Electrocardiography, Age, Risk Factors, Troponin HEART ve Thrombolysis in Myocardial Infarction TIMI skorlarının düşük riskli akut koroner sendrom AKS, hastalarını belirleme ve 30 günlük majör istenmeyen kardiyak olayları MİKO öngörme performanslarını karşılaştırmayı amaçlamıştır. Gereç ve Yöntem: Bu prospektif çalışmaya, travmatik olmayan göğüs ağrısı ile ASye başvuran ve AKS açısından değerlendirilen 18 yaş ve üzeri hastalar dahil edilmiştir. HEART, TIMI, EDACS ve EDACS-ADP skorları hesaplanmıştır. Miyokard enfarktüsü, acil revaskülarizasyon veya ölüm MİKO olarak tanımlanmış ve telefonla takip yoluyla doğrulanmıştır. Tanısal performans, eğri altındaki alan EAA analizleri ile değerlendirilmiştir. Bulgular: Çalışmaya 408 hasta dahil edilmiş ve 64ünde 15.7 MİKO gelişmiştir. En yüksek EAA değeri HEART skoruna 0,823 aitken, bunu TIMI 0,784, EDACS-ADP 0,769 ve EDACS 0,716 takip etmiştir. HEART, en yüksek duyarlılık 90,6 ve negatif prediktif değer NPD, 97,2 göstermiştir. TIMInin 1 kesim değerinde duyarlılık 81,3 ve NPD 94,7 iken, kesim değerinin 1e düşürülmesi duyarlılığı 96,8 ve NPDyi 98,8e çıkarmıştır. EDACS, 56,2 duyarlılık ve 90,3 NPD gösterirken, EDACS-ADP 82,8 duyarlılık ve 95,7 NPD göstermiştir. Sonuç: HEART skoru, 30 günlük MİKOyu öngörmede TIMI, EDACS ve EDACS-ADPden üstün performans göstermiş, en iyi duyarlılık ve NPDye sahip olmuştur. TIMI kesim değerinin ayarlanması tanısal performansı artırabilir, ancak ASde kalış süresini uzatabilir. HEART skoru, düşük riskli AKS hastalarını belirlemek ve güvenli taburculuk kararlarını desteklemek için en güvenilir araçtır.

Article Details

Comparison of acute coronary syndrome decision aids in the emergency department

Authors:

Mehmet Seyfettin Sarıbaş | Atakan Savrun | Ali Aygun | Şeyda Tuba Savrun

Publisher:

Cukurova University

Main Topics:

Acil Tıp

Journal:

Cukurova Medical Journal Vol.49 Issue 4, pp.1030-1043

Document Type:

Article

Publication Date:

12/2024

Document Language:

English

Document ID (Org No.):

2001329044

pISSN:

2602-3032

Acute Coronary Syndrome

Chest pain

EDACS

HEART

MACE

TIMIAkut koroner sendrom

EDACS

HEART

Göğüs ağrısı

MİKO

TIMI

Issues

Article Details

Authors: Mehmet Seyfettin Sarıbaş | Atakan Savrun | Ali Aygun | Şeyda Tuba Savrun

Publisher: Cukurova University

Main Topics: Acil Tıp

Journal: Cukurova Medical Journal Vol.49 Issue 4, pp.1030-1043

Document Type: Article

Publication Date: 12/2024

Document Language: English

Document ID (Org No.): 2001329044

pISSN: 2602-3032

Issues

Authors:

Mehmet Seyfettin Sarıbaş | Atakan Savrun | Ali Aygun | Şeyda Tuba Savrun

Publisher:

Cukurova University

Main Topics:

Acil Tıp

Journal:

Cukurova Medical Journal Vol.49 Issue 4, pp.1030-1043

Document Type:

Article

Publication Date:

12/2024

Document Language:

English

Document ID (Org No.):

2001329044

pISSN:

2602-3032