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Validation of the ACC Expert Consensus Decision Pathway for Patients With Chest Pain.
Mahler, Simon A; Ashburn, Nicklaus P; Supples, Michael W; Hashemian, Tara; Snavely, Anna C.
Afiliación
  • Mahler SA; Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA; Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA; Department of Implementation Science, Wake Forest University Scho
  • Ashburn NP; Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
  • Supples MW; Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
  • Hashemian T; Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
  • Snavely AC; Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA; Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
J Am Coll Cardiol ; 83(13): 1181-1190, 2024 Apr 02.
Article en En | MEDLINE | ID: mdl-38538196
ABSTRACT

BACKGROUND:

The American College of Cardiology (ACC) recently published an Expert Consensus Decision Pathway for chest pain.

OBJECTIVES:

The purpose of this study was to validate the ACC Pathway in a multisite U.S.

METHODS:

An observational cohort study of adults with possible acute coronary syndrome was conducted. Patients were accrued from 5 U.S. Emergency Departments (November 1, 2020, to July 31, 2022). ECGs and 0- and 2-hour high-sensitivity troponin (Beckman Coulter) measures were used to stratify patients according to the ACC Pathway. The primary safety outcome was 30-day all-cause death or myocardial infarction (MI). Efficacy was defined as the proportion stratified to the rule-out zone. Negative predictive value for 30-day death or MI was assessed among the whole cohort and in a subgroup of patients with coronary artery disease (CAD) (prior MI, revascularization, or ≥70% coronary stenosis).

RESULTS:

ACC Pathway assessments were complete in 14,395 patients, of whom 51.7% (7,437 of 14,395) were women with a median age of 56 years (Q1-Q3 44-68 years). Known CAD was present in 23.5% (3,386 of 14,395) and 30-day death or MI occurred in 8.1% (1,168 of 14,395). The ACC Pathway had an efficacy of 48.1% (95% CI 47.3%-49.0%). Among patients in the rule-out zone, 0.3% (22 of 6,930) had death or MI at 30 days, yielding a negative predictive value of 99.7% (95% CI 99.5%-99.8%). In patients with known CAD, 20.0% (676 of 3,386) were classified to the rule-out zone, of whom 1.5% (10 of 676) had death or MI.

CONCLUSIONS:

The ACC expert consensus decision pathway was safe and efficacious. However, it may not be safe for use among patients with known CAD.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cardiología / Síndrome Coronario Agudo / Infarto del Miocardio Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: J Am Coll Cardiol Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cardiología / Síndrome Coronario Agudo / Infarto del Miocardio Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: J Am Coll Cardiol Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos