A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study

Than, Martin; Cullen, Louise; Reid, Christopher M.; Lim, Swee Han; Aldous, Sally; Ardagh, Michael; Peacock, W. Frank; Parsonage, William; Ho, Hiu Fai; Ko, Hiu Fai; Kasliwal, Ravi R; Bansal, Manish; Soerianata, Sunarya; Hu, Dayi; Ding, Rongjing; Hua, Qi; Kang, Seok Min; Sritara, Piyamitr; Saelee, Ratchanee; Chiu, Te Fa; Tsai, Kun-Tong; Chu, Fang; Chen, Wei Kung; Chang, Wen-Han; Flaws, Dylan; George, Peter M.; Richards, A. Mark

doi:10.1016/s0140-6736(11)60310-3

Cited by 316 publications

(278 citation statements)

References 40 publications

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“…In fact, the landmark ASPECT study, which used an accelerated POCT protocol in 3582 suspected acute coronary syndrome (ACS) patients, reported that only 9.8% could be safely discharged 2 h after presentation [16]. In contrast, the ADAPT/APACE studies, which investigated the utility of a slower central laboratory assay albeit with a higher sensitivity to troponin in 2044 patients, showed that this platform resulted in 41.5% of patients being discharged from the ED early [17].…”

Section: Troponin Point-of-care Testingmentioning

confidence: 99%

“…However, the situation may change with the introduction of high-sensitivity POCT as high-sensitive troponin tests have been shown to effectively rule out acute MI in as little as 2 h [16,17], meaning that more than 40% of patients reporting chest pain can be immediately discharged from the ED. Moreover, for patients at high risk of ACS a myocardial perfusion evaluation should be performed on the same day rather than waiting for the 6 h of serial marker evaluation [17].…”

Section: Troponin Point-of-care Testingmentioning

confidence: 99%

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Opinion paper on utility of point-of-care biomarkers in the emergency department pathways decision making

Somma

Zampini

Vetrone

et al. 2014

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:Overcrowding of the emergency department (ED) is rapidly becoming a global challenge and a major source of concern for emergency physicians. The evaluation of cardiac biomarkers is critical for confirming diagnoses and expediting treatment decisions to reduce overcrowding, however, physicians currently face the dilemma of choosing between slow and accurate central-based laboratory tests, or faster but imprecise assays. With improvements in technology, point-of-care testing (POCT) systems facilitate the efficient and high-throughput evaluation of biomarkers, such as troponin (cTn), brain natriuretic peptide (BNP) and neutrophil gelatinase-associated lipocalin (NGAL). In this context, POCT may help ED physicians to confirm a diagnosis of conditions, such as acute coronary syndrome, heart failure or kidney damage. Compared with classic laboratory methods, the use of cTn, BNP, and NGAL POCT has shown comparable sensitivity, specificity and failure rate, but with the potential to provide prompt and accurate diagnosis, shorten hospital stay, and alleviate the burden on the ED. Despite this potential, the full advantages of rapid delivery results will only be reached if POCT is implemented within hospital standardized procedures and ED staff receive appropriate training.

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Section: Troponin Point-of-care Testingmentioning

confidence: 99%

Section: Troponin Point-of-care Testingmentioning

confidence: 99%

Opinion paper on utility of point-of-care biomarkers in the emergency department pathways decision making

Somma

Zampini

Vetrone

et al. 2014

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…Biomarkers such as N-terminal pro b-type natriuretic peptide (NT-proBNP) or high sensitivity C-reactive protein (hsCRP) identify ACS patients at increased risk of death, irrespective if troponin is elevated or not. 38 A metaanalysis showed a triple rule-out test (troponin, IMA, ECG) had a negative predictive value of 97% for ACS and 94.5% for longer term outcomes although the added value of IMA was not clear. 39 Further studies are required to understand if and how these 'novel' markers can be useful in clinical practice.…”

Section: Unstable Angina Myocardial Ischaemia and Other Biomarkersmentioning

confidence: 99%

“…This triage can be achieved very rapidly. Two large studies, one a randomised controlled trial 37 and the other an observational study, 38 have shown that failure of troponin to increase during the two-hour period following admission defines a low-risk group which can be safely discharged. Triage of acute onset chest pain is now a biochemical rule-out test based on troponin because it is fast and accurate.…”

Section: Po Collinsonmentioning

confidence: 99%

Triage of acute onset chest pain: now a biochemical rule-out test?

Bloomfield²,

Po³

2012

J R Coll Physicians Edinb

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“…The former facilitates earlier planning of treatment and the latter helps avoids unnecessary inpatient admissions. Historically, most patients with symptoms suggestive of AMI undergo prolonged assessment, either in the ED or as hospital in-patients even though three quarters of these patients ultimately do not have a final diagnosis of AMI [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

The utility of presentation and 4-hour high sensitivity troponin I to rule-out acute myocardial infarction in the emergency department

Pickering

Young²,

George

et al. 2015

Clinical Biochemistry

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The utility of presentation and 4-hour high sensitivity troponin I to rule-out acute myocardial infarction in the emergency department, Clinical Biochemistry (2015Biochemistry ( ), doi: 10.1016Biochemistry ( /j.clinbiochem.2015 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.The utility of presentation and 4-hour high sensitivity troponin I to rule-out acute myocardial infarction in the emergency department. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT2 Abstract a) Objectives: International guidance recommends that early serial sampling of high sensitivity troponin be used to accurately identify acute myocardial infarction (AMI) in chest pain patients.The background evidence for this approach is limited. We evaluated whether on presentation and 4-hour high-sensitivity troponin I (hs-cTnI) could be used to accurately rule-out AMI.b) Design and Methods: hs-cTnI was measured on presentation and at 4-hours in adult patients attending an emergency department with possible acute coronary syndrome. We determined the sensitivity for AMI for at least one hs-cTnI above the 99th percentile for a healthy population or alone or in combination with new ischemic ECG changes. Both overall and sex-specific 99th percentiles were assessed.. Patients with negative tests were designated low-risk. d) Conclusion: Hs-cTnI >99th percentile thresholds measured on presentation and at 4-hours was not a safe strategy to rule-out AMI in this clinical setting irrespective of whether sex-specific 99th percentiles were used, or whether hs-cTnI was combined with ECG results.

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A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study

Cited by 316 publications

References 40 publications

Opinion paper on utility of point-of-care biomarkers in the emergency department pathways decision making

Opinion paper on utility of point-of-care biomarkers in the emergency department pathways decision making

Triage of acute onset chest pain: now a biochemical rule-out test?

The utility of presentation and 4-hour high sensitivity troponin I to rule-out acute myocardial infarction in the emergency department

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