Improved Assessment of Chest pain Trial (IMPACT): assessing patients with possible acute coronary syndromes

Abstract

Australian New Zealand Clinical Trials Registry ACTRN12611000206921.

Characteristics and occurrence of type 2 myocardial infarction in emergency department patients: a prospective study

“…The first was a prospective observational study of 986 adult patients presenting to the ED between November 2008 and February 2011 14. The second study was an intervention trial that included 1366 adult patients presenting to the ED between February 2011 and March 2014 15. The study protocols were approved by the Human Research Ethics committee (HREC2008/101 and HREC/10/QRBW/403) and complied with the Declaration of Helsinki.…”

Less is more: chest pain pathways in clinical care

“…A clinical pathway would ideally expedite care for a greater proportion of patients than the 10–20% achieved by ADAPT, ASPECT and IMPACT, but extending the approach to patients at greater risk might result in a higher miss rate than is clinically acceptable. When the IMPACT risk tool was combined with judicious inpatient testing, the rate of undiagnosed ACS in an intermediate risk cohort of patients was 0.12% 2 . Although promising, this finding requires further validation before the approach is more widely adopted.…”

“…The Improved Assessment of Chest pain Trial (IMPACT) applied a rapid risk stratification tool for identifying patients at low short term (30‐day) risk of an ACS who could be safely discharged home without additional cardiac testing 2 . The strengths of IMPACT included its large cohort of patients, the intuitiveness of the assessment tool, and its inclusion of broader outcome measures important to clinicians and patients.…”

“…Additional diagnostic testing of patients with low risk chest pain is controversial. The patients categorised by IMPACT as low risk were young (mean age, 33.8 years), but 24% underwent objective testing at the request of a clinician, usually exercise electrocardiography (ECG); the authors concluded that “discharging patients with normal findings from this low risk, inexpensive and widely available investigation is safe.” 2 The utility of exercise ECG for risk stratification of low risk patients, however, is limited, and testing does not influence revisit rates for similar symptoms 9 . Several guidelines recommend against testing patients at low risk; 10 , 11 false positive results can lead to a cascade of inappropriate intervention and the risk of harm.…”

Improved Assessment of Chest pain Trial (IMPACT): assessing patients with possible acute coronary syndrome

“…Cullen and colleagues are to be congratulated on their most recent contribution to the assessment of emergency department patients presenting with possible acute coronary syndrome 1 . The ability to safely reduce length of stay for a larger proportion of patients compared with the ADAPT study, pending external validation, is promising 1 …”