Related Experiment Video

Updated: Apr 5, 2026

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

24.9K

Retrospective Evaluation of Two Fast-track Strategies to Rule Out Acute Coronary Syndrome in a Real-life Chest Pain

Martin Schønemann-Lund1, Mikkel Malby Schoos2, Kasper Iversen3

  • 1Department of Internal Medicine, Hudiksvalls Sjukhus, Hudiksvall, Sweden.

The Journal of Emergency Medicine
|August 19, 2015
PubMed

Insights

A new European Society of Cardiology (ESC) guideline protocol for ruling out non-ST-elevation acute coronary syndrome (N-STE ACS) was evaluated. A simpler protocol using undetectable high-sensitivity troponin T (hs-TnT) levels showed similar or superior sensitivity for diagnosing N-STE ACS.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Diagnostic Testing

Background:

  • The European Society of Cardiology (ESC) introduced a new protocol for ruling out non-ST-elevation acute coronary syndrome (N-STE ACS).
  • This protocol involves diagnostic levels of high-sensitivity troponin T (hs-TnT).

Purpose of the Study:

  • To evaluate a modified ESC rule-out protocol (Protocol 1) using hs-TnT.
  • To compare Protocol 1 with a simpler approach (Protocol 2) using undetectable hs-TnT levels for ruling out patients.
  • To assess diagnostic accuracy, re-admission rates, and mortality.

Main Methods:

  • 534 patients with suspected ACS were included.
  • Protocol 1: symptom duration, hs-TnT at 0 and 6-9h, GRACE score, symptom status at 6-9h.
  • Protocol 2: single hs-TnT blood sample.

Main Results:

  • Protocol 1 ruled out 27.9% of patients, with 87.3% sensitivity and 87.6% negative predictive value for ACS.
  • Protocol 2 ruled out 17.5% of patients, achieving 94.1% sensitivity and 90.8% negative predictive value.
  • Both protocols demonstrated effectiveness in identifying patients with adverse outcomes.

Conclusions:

  • The modified ESC rule-out protocol (Protocol 1) is diagnostically valuable for N-STE ACS.
  • A simpler protocol (Protocol 2) using undetectable hs-TnT levels may offer similar or superior sensitivity.
  • Further validation of Protocol 2 is suggested for efficient N-STE ACS rule-out.
Abstract

Keywords:
acute coronary syndromelimit of detectionsensitivityspecificitytriagetroponinundetectable levels

More Related Videos

Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease06:16

Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease

Published on: August 9, 2024

1.1K
Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control05:41

Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control

Published on: December 16, 2022

4.7K

Related Concept Videos

Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
456
Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
418
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
469
Angina III: Clinical Manifestations and Assessment01:29

Angina III: Clinical Manifestations and Assessment

Angina manifests as chest pain, tightness, or squeezing discomfort typically located behind the breastbone. It can radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, most commonly the left arm. Patients may experience shortness of breath, fatigue, profuse sweating, dizziness, indigestion, heartburn, palpitations, anxiety, and vomiting as accompanying symptoms. This pain often lasts a few minutes and is triggered by physical exertion, emotional stress, heavy meals, or cold...
406
Imaging Studies for Cardiovascular System I:Echocardiography01:17

Imaging Studies for Cardiovascular System I:Echocardiography

Cardiac imaging studies encompass a wide range of noninvasive and minimally invasive techniques designed to visualize the heart's structure and function in detail. One such technique is echocardiography, which uses high-frequency ultrasound waves to produce detailed images of the heart, known as echocardiograms.
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
930
Acute Coronary Syndrome V: Nursing Management01:26

Acute Coronary Syndrome V: Nursing Management

Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
555