An Evaluation of a Diagnostic Protocol to Screen Acute Cardiac Ischemia in an Emergency Setting

Kim, Gab Teug

Abstract

PURPOSE: Evaluating chest pain is one of the greatest challenges facing emergency physicians. Accurate diagnosis and triage of patients with acute cardiac ischemia (ACI) containing acute myocardial infarction (AMI) and unstable angina at the emergency department should increase survival for such patients.
METHODS
In 333 patients with chest pain, we evaluated the diagnostic performance of creatine kinase-MB (CK-MB), electrocardiograms (ECG), Cardiac STATus(TH), the Goldman chest-pain protocol, and a combination of Cardiac STATus(TH) and the Goldman chest-pain protocol. Diagnostic performance was assessed using estimates of test sensitivity, specificity, and diagnostic odds ratio.
RESULTS
Diagnostic technologies for AMI, such as CK-MB, ECG, Cardiac STATus(TH), and the Goldman chest-pain protocol have good sensitivity (80-90%), but they have poor sensitivity for ACI (60-70%). To increase the diagnostic accuracy for ACI we combined the Cardiac STATus(TH) and the Goldman chest-pain protocol. The combination had excellent sensitivity (97%) for AMI at 4 hours after onset of chest pain. However the combination did not have the desired very high sensitivity to diagnose ACI (78.5%). With serial Cardiac STATus(TH), ECG, and echocardiography measurements in the chest-pain observation unit, we improved the ACI detection rate.
CONCLUSION
The combination of Cardiac STATus(TH) and the Goldman chest-pain protocol had excellent diagnostic performance for AMI and good performance for ACI.