[Risk stratification and role for additional diagnostic testing in patients with acute chest pain and normal...

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Diagnostics

Background:

• Normal high sensitivity cardiac troponin (hs-cTn) assays accurately rule out acute myocardial infarction (AMI).
• Additional non-invasive testing is often ordered despite normal hs-cTn results.
• Current diagnostic strategies may lead to unnecessary tests in low-risk patients.

Purpose of the Study:

• To evaluate if clinical characteristics can stratify risk in patients with acute chest pain and normal hs-cTn.
• To determine if risk stratification can guide the need for additional non-invasive testing.
• To assess the diagnostic yield of additional tests based on clinical risk.

Main Methods:

• Observational study of 918 patients with acute chest pain and normal hs-cTnT.
• One-year follow-up for major adverse cardiac events (MACE) and non-invasive test results.
• Classification of patients into low and high risk based on clinical characteristics.

Main Results:

• 6.4% of patients experienced MACE, primarily revascularizations.
• Absence of abnormal stress tests and suspicious history identified 86% of patients at very low risk (0.4% MACE at 30 days).
• Most additional tests (83%) were performed in low-risk patients with low diagnostic yield (8% abnormal, 17% PPV for MACE), while high-risk patients had higher yields (40% abnormal, 70% PPV for MACE).

Conclusions:

• Clinical characteristics effectively identify low-risk patients with acute chest pain and normal hs-cTnT.
• Current emergency department strategies lead to excessive testing in low-risk patients with low diagnostic yield.
• Risk stratification using clinical factors can optimize the use of additional diagnostic tests.