EBQ:ADAPT Trial 2-Hour Troponin Rule Out

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incomplete Journal Club Article
Than M.. "2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial". Journal of the American College of Cardiology. 2012. 59(23):2091-2098.
PubMed Full text PDF

Clinical Question

Can an accelerated diagnostic protocol (ADP) for chest pain be used to identify low-risk patients suitable for discharge with close followup?

Conclusion

An ADP can successfully identify low risk chest pain patients for discharge from the emergency department and decrease observational stay.

Major Points

  • The ADP relies on a combination of 2 negative troponins, a TIMI score < 0 and no ischemic changes on ECG.
  • The ADP successfully classifies patients as low risk and has a sensitivity of 99.7 for identifying patients who will have Major Adverse Cardiac Events (MACE)
  • Patients who are not low risk according to the ADP should continue to be managed with existing clinical care that involves extended observation or admission.
  • Patients with a negative troponin at 0 hours and 2 hrs, a TIMI<0 and no ischemic ECG changes can be discharged with close cardiac followup.

Design

Population

Inclusion Criteria

Exclusion Criteria

Baseline Characteristics

Interventions

Outcomes

Primary Outcomes

Secondary Outcomes

Subgroup Analysis

Criticisms

Funding

CME


Sources