Validation of the (Troponin-only) Manchester ACS decision aid with a contemporary cardiac troponin I assay.
Identifieur interne : 000C10 ( Main/Exploration ); précédent : 000C09; suivant : 000C11Validation of the (Troponin-only) Manchester ACS decision aid with a contemporary cardiac troponin I assay.
Auteurs : Patricia Va Den Berg [Pays-Bas] ; Gillian Burrows [Royaume-Uni] ; Philip Lewis [Royaume-Uni] ; Simon Carley [Royaume-Uni] ; Richard Body [Royaume-Uni]Source :
- The American journal of emergency medicine [ 1532-8171 ] ; 2018.
Descripteurs français
- KwdFr :
- Adulte d'âge moyen (MeSH), Douleur thoracique (diagnostic), Femelle (MeSH), Hospitalisation (statistiques et données numériques), Humains (MeSH), Marqueurs biologiques (sang), Mâle (MeSH), Protéines de liaison aux acides gras (sang), Royaume-Uni (MeSH), Service hospitalier d'urgences (statistiques et données numériques), Sujet âgé (MeSH), Sujet âgé de 80 ans ou plus (MeSH), Syndrome coronarien aigu (diagnostic), Syndrome coronarien aigu (physiopathologie), Techniques d'aide à la décision (MeSH), Troponine T (sang), Valeur prédictive des tests (MeSH), Études prospectives (MeSH).
- MESH :
- diagnostic : Douleur thoracique, Syndrome coronarien aigu.
- physiopathologie : Syndrome coronarien aigu.
- sang : Marqueurs biologiques, Protéines de liaison aux acides gras, Troponine T.
- statistiques et données numériques : Hospitalisation, Service hospitalier d'urgences.
- Adulte d'âge moyen, Femelle, Humains, Mâle, Royaume-Uni, Sujet âgé, Sujet âgé de 80 ans ou plus, Techniques d'aide à la décision, Valeur prédictive des tests, Études prospectives.
- Wicri :
- geographic : Royaume-Uni.
English descriptors
- KwdEn :
- Acute Coronary Syndrome (diagnosis), Acute Coronary Syndrome (physiopathology), Aged (MeSH), Aged, 80 and over (MeSH), Biomarkers (blood), Chest Pain (diagnosis), Decision Support Techniques (MeSH), Emergency Service, Hospital (statistics & numerical data), Fatty Acid-Binding Proteins (blood), Female (MeSH), Hospitalization (statistics & numerical data), Humans (MeSH), Male (MeSH), Middle Aged (MeSH), Predictive Value of Tests (MeSH), Prospective Studies (MeSH), Troponin T (blood), United Kingdom (MeSH).
- MESH :
- chemical , blood : Biomarkers, Fatty Acid-Binding Proteins, Troponin T.
- geographic : United Kingdom.
- diagnosis : Acute Coronary Syndrome, Chest Pain.
- physiopathology : Acute Coronary Syndrome.
- statistics & numerical data : Emergency Service, Hospital, Hospitalization.
- Aged, Aged, 80 and over, Decision Support Techniques, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies.
Abstract
OBJECTIVES
The Manchester Acute Coronary Syndromes (MACS) decision aid can 'rules in' and 'rule out' acute coronary syndromes (ACS) by combining a patient's symptoms with the results of a single blood test taken at the time of arrival in the Emergency Department (ED). The original model (MACS) included two biomarkers: high sensitivity cardiac troponin T (hs-cTnT) and heart-type fatty acid binding protein (h-FABP). A refined model without h-FABP was found to have comparable sensitivity but greater specificity. We sought to validate MACS and T-MACS using the contemporary Siemens Advia Centaur cardiac troponin I assay to increase usability in practice.
METHODS
This is a secondary analysis from prospective diagnostic cohort study at Stepping Hill Hospital, United Kingdom. Patients presenting with chest pain of suspected cardiac nature warranting rule out for ACS were included. All patients underwent hs-cTnT testing at least 12h after peak symptoms. The primary outcome was a diagnosis of ACS, defined as either prevalent acute myocardial infarction (AMI) or incident major adverse cardiac events (death, AMI or coronary revascularization) within 30days.
RESULTS
Of 405 included patients, 76 (18.8%) had ACS. MACS and T-MACS had similar C-statistics (0.94 for each, p=0.36) and sensitivity (difference 1.3%, 95% CI -1.3 to 3.9%, p=1.00) but T-MACS had significantly greater specificity (difference 16.7%, 95% CI 14.6-18.9%, p<0.0001). T-MACS and MACS would have allowed 36.3% and 22.5% patients to be immediately discharged respectively. Of patients classified as 'very low risk', none had ACS when MACS was used compared to one (0.7%) with T-MACS.
CONCLUSION
Both MACS and T-MACS effectively ruled out ACS even with a contemporary troponin I assay and could be used to reduce unnecessary hospital admissions.
DOI: 10.1016/j.ajem.2017.09.032
PubMed: 29079376
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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Electronic address: richard.body@manchester.ac.uk.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom; Manchester Metropolitan University, United Kingdom; The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester M13 9PL</wicri:regionArea><wicri:noRegion>Manchester M13 9PL</wicri:noRegion></affiliation></author></analytic><series><title level="j">The American journal of emergency medicine</title><idno type="eISSN">1532-8171</idno><imprint><date when="2018" type="published">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acute Coronary Syndrome (diagnosis)</term><term>Acute Coronary Syndrome (physiopathology)</term><term>Aged (MeSH)</term><term>Aged, 80 and over (MeSH)</term><term>Biomarkers (blood)</term><term>Chest Pain (diagnosis)</term><term>Decision Support Techniques (MeSH)</term><term>Emergency Service, Hospital (statistics & numerical data)</term><term>Fatty Acid-Binding Proteins (blood)</term><term>Female (MeSH)</term><term>Hospitalization (statistics & numerical data)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Predictive Value of Tests (MeSH)</term><term>Prospective Studies (MeSH)</term><term>Troponin T (blood)</term><term>United Kingdom (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte d'âge moyen (MeSH)</term><term>Douleur thoracique (diagnostic)</term><term>Femelle (MeSH)</term><term>Hospitalisation (statistiques et données numériques)</term><term>Humains (MeSH)</term><term>Marqueurs biologiques (sang)</term><term>Mâle (MeSH)</term><term>Protéines de liaison aux acides gras (sang)</term><term>Royaume-Uni (MeSH)</term><term>Service hospitalier d'urgences (statistiques et données numériques)</term><term>Sujet âgé (MeSH)</term><term>Sujet âgé de 80 ans ou plus (MeSH)</term><term>Syndrome coronarien aigu (diagnostic)</term><term>Syndrome coronarien aigu (physiopathologie)</term><term>Techniques d'aide à la décision (MeSH)</term><term>Troponine T (sang)</term><term>Valeur prédictive des tests (MeSH)</term><term>Études prospectives (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Biomarkers</term><term>Fatty Acid-Binding Proteins</term><term>Troponin T</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>United Kingdom</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Acute Coronary Syndrome</term><term>Chest Pain</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Douleur thoracique</term><term>Syndrome coronarien aigu</term></keywords><keywords scheme="MESH" qualifier="physiopathologie" xml:lang="fr"><term>Syndrome coronarien aigu</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Acute Coronary Syndrome</term></keywords><keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Marqueurs biologiques</term><term>Protéines de liaison aux acides gras</term><term>Troponine T</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Emergency Service, Hospital</term><term>Hospitalization</term></keywords><keywords scheme="MESH" qualifier="statistiques et données numériques" xml:lang="fr"><term>Hospitalisation</term><term>Service hospitalier d'urgences</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Decision Support Techniques</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Predictive Value of Tests</term><term>Prospective Studies</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte d'âge moyen</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Royaume-Uni</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Techniques d'aide à la décision</term><term>Valeur prédictive des tests</term><term>Études prospectives</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Royaume-Uni</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVES</b></p><p>The Manchester Acute Coronary Syndromes (MACS) decision aid can 'rules in' and 'rule out' acute coronary syndromes (ACS) by combining a patient's symptoms with the results of a single blood test taken at the time of arrival in the Emergency Department (ED). The original model (MACS) included two biomarkers: high sensitivity cardiac troponin T (hs-cTnT) and heart-type fatty acid binding protein (h-FABP). A refined model without h-FABP was found to have comparable sensitivity but greater specificity. We sought to validate MACS and T-MACS using the contemporary Siemens Advia Centaur cardiac troponin I assay to increase usability in practice.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>This is a secondary analysis from prospective diagnostic cohort study at Stepping Hill Hospital, United Kingdom. Patients presenting with chest pain of suspected cardiac nature warranting rule out for ACS were included. All patients underwent hs-cTnT testing at least 12h after peak symptoms. The primary outcome was a diagnosis of ACS, defined as either prevalent acute myocardial infarction (AMI) or incident major adverse cardiac events (death, AMI or coronary revascularization) within 30days.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Of 405 included patients, 76 (18.8%) had ACS. MACS and T-MACS had similar C-statistics (0.94 for each, p=0.36) and sensitivity (difference 1.3%, 95% CI -1.3 to 3.9%, p=1.00) but T-MACS had significantly greater specificity (difference 16.7%, 95% CI 14.6-18.9%, p<0.0001). T-MACS and MACS would have allowed 36.3% and 22.5% patients to be immediately discharged respectively. Of patients classified as 'very low risk', none had ACS when MACS was used compared to one (0.7%) with T-MACS.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>Both MACS and T-MACS effectively ruled out ACS even with a contemporary troponin I assay and could be used to reduce unnecessary hospital admissions.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">29079376</PMID><DateCompleted><Year>2018</Year><Month>11</Month><Day>23</Day></DateCompleted><DateRevised><Year>2019</Year><Month>12</Month><Day>10</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1532-8171</ISSN><JournalIssue CitedMedium="Internet"><Volume>36</Volume><Issue>4</Issue><PubDate><Year>2018</Year><Month>Apr</Month></PubDate></JournalIssue><Title>The American journal of emergency medicine</Title><ISOAbbreviation>Am J Emerg Med</ISOAbbreviation></Journal><ArticleTitle>Validation of the (Troponin-only) Manchester ACS decision aid with a contemporary cardiac troponin I assay.</ArticleTitle><Pagination><MedlinePgn>602-607</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S0735-6757(17)30757-X</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.ajem.2017.09.032</ELocationID><Abstract><AbstractText Label="OBJECTIVES" NlmCategory="OBJECTIVE">The Manchester Acute Coronary Syndromes (MACS) decision aid can 'rules in' and 'rule out' acute coronary syndromes (ACS) by combining a patient's symptoms with the results of a single blood test taken at the time of arrival in the Emergency Department (ED). The original model (MACS) included two biomarkers: high sensitivity cardiac troponin T (hs-cTnT) and heart-type fatty acid binding protein (h-FABP). A refined model without h-FABP was found to have comparable sensitivity but greater specificity. We sought to validate MACS and T-MACS using the contemporary Siemens Advia Centaur cardiac troponin I assay to increase usability in practice.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">This is a secondary analysis from prospective diagnostic cohort study at Stepping Hill Hospital, United Kingdom. Patients presenting with chest pain of suspected cardiac nature warranting rule out for ACS were included. All patients underwent hs-cTnT testing at least 12h after peak symptoms. The primary outcome was a diagnosis of ACS, defined as either prevalent acute myocardial infarction (AMI) or incident major adverse cardiac events (death, AMI or coronary revascularization) within 30days.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Of 405 included patients, 76 (18.8%) had ACS. MACS and T-MACS had similar C-statistics (0.94 for each, p=0.36) and sensitivity (difference 1.3%, 95% CI -1.3 to 3.9%, p=1.00) but T-MACS had significantly greater specificity (difference 16.7%, 95% CI 14.6-18.9%, p<0.0001). T-MACS and MACS would have allowed 36.3% and 22.5% patients to be immediately discharged respectively. Of patients classified as 'very low risk', none had ACS when MACS was used compared to one (0.7%) with T-MACS.</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">Both MACS and T-MACS effectively ruled out ACS even with a contemporary troponin I assay and could be used to reduce unnecessary hospital admissions.</AbstractText><CopyrightInformation>Copyright © 2017. Published by Elsevier Inc.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Va Den Berg</LastName><ForeName>Patricia</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Maastricht University, Faculty of Health, Medicine & Life Sciences Maastricht University, Universiteitssingel, Maastricht, The Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Burrows</LastName><ForeName>Gillian</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Stockport NHS Foundation Trust, Poplar Grove, Stockport, United Kingdom.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lewis</LastName><ForeName>Philip</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Stockport NHS Foundation Trust, Poplar Grove, Stockport, United Kingdom.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Carley</LastName><ForeName>Simon</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom; Manchester Metropolitan University, United Kingdom.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Body</LastName><ForeName>Richard</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom; Manchester Metropolitan University, United Kingdom; The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester M13 9PL, United Kingdom. Electronic address: richard.body@manchester.ac.uk.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>PDF-2012-05-193</GrantID><Agency>Department of Health</Agency><Country>United Kingdom</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D023361">Validation Study</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2017</Year><Month>09</Month><Day>23</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Am J Emerg Med</MedlineTA><NlmUniqueID>8309942</NlmUniqueID><ISSNLinking>0735-6757</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D015415">Biomarkers</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D050556">Fatty Acid-Binding Proteins</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D020107">Troponin T</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D054058" MajorTopicYN="N">Acute Coronary Syndrome</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015415" MajorTopicYN="N">Biomarkers</DescriptorName><QualifierName UI="Q000097" MajorTopicYN="N">blood</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002637" MajorTopicYN="N">Chest Pain</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003661" MajorTopicYN="Y">Decision Support Techniques</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004636" MajorTopicYN="N">Emergency Service, Hospital</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D050556" MajorTopicYN="N">Fatty Acid-Binding Proteins</DescriptorName><QualifierName UI="Q000097" MajorTopicYN="N">blood</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006760" MajorTopicYN="N">Hospitalization</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011237" MajorTopicYN="N">Predictive Value of Tests</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D020107" MajorTopicYN="N">Troponin T</DescriptorName><QualifierName UI="Q000097" MajorTopicYN="Y">blood</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006113" MajorTopicYN="N" Type="Geographic">United Kingdom</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Acute coronary syndromes</Keyword><Keyword MajorTopicYN="N">Cardiac troponin</Keyword><Keyword MajorTopicYN="N">Clinical decision rules</Keyword><Keyword MajorTopicYN="N">Sensitivity and specificity</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2017</Year><Month>08</Month><Day>11</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2017</Year><Month>09</Month><Day>13</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2017</Year><Month>09</Month><Day>16</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2017</Year><Month>10</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2018</Year><Month>11</Month><Day>24</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2017</Year><Month>10</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">29079376</ArticleId><ArticleId IdType="pii">S0735-6757(17)30757-X</ArticleId><ArticleId IdType="doi">10.1016/j.ajem.2017.09.032</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Pays-Bas</li><li>Royaume-Uni</li></country></list><tree><country name="Pays-Bas"><noRegion><name sortKey="Va Den Berg, Patricia" sort="Va Den Berg, Patricia" uniqKey="Va Den Berg P" first="Patricia" last="Va Den Berg">Patricia Va Den Berg</name></noRegion></country><country name="Royaume-Uni"><noRegion><name sortKey="Burrows, Gillian" sort="Burrows, Gillian" uniqKey="Burrows G" first="Gillian" last="Burrows">Gillian Burrows</name></noRegion><name sortKey="Body, Richard" sort="Body, Richard" uniqKey="Body R" first="Richard" last="Body">Richard Body</name><name sortKey="Carley, Simon" sort="Carley, Simon" uniqKey="Carley S" first="Simon" last="Carley">Simon Carley</name><name sortKey="Lewis, Philip" sort="Lewis, Philip" uniqKey="Lewis P" first="Philip" last="Lewis">Philip Lewis</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix 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