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Performance of the EDACS-accelerated Diagnostic Pathway in a Cohort of US Patients with Acute Chest Pain

Stopyra, Jason P. MD*; Miller, Chadwick D. MD, MS*; Hiestand, Brian C. MD*; Lefebvre, Cedric W. MD*; Nicks, Bret A. MD*; Cline, David M. MD*; Askew, Kim L. MD*; Riley, Robert F. MD; Russell, Gregory B. MS; Hoekstra, James W. MD*; Mahler, Simon A. MD, MS*

Critical Pathways in Cardiology: December 2015 - Volume 14 - Issue 4 - p 134–138
doi: 10.1097/HPC.0000000000000059
Original Articles
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Background: The Emergency Department Assessment of Chest pain Score-Accelerated Diagnostic Protocol (EDACS-ADP) is a decision aid designed to safely identify emergency department (ED) patients with chest pain for early discharge. Derivation and validation studies in Australasia have demonstrated high sensitivity (99%–100%) for major adverse cardiac events (MACE).

Objectives: To validate the EDACS-ADP in a cohort of US ED patients with symptoms suspicious for acute coronary syndrome (ACS).

Methods: A secondary analysis of participants enrolled in the HEART Pathway Randomized Controlled Trial was conducted. This single-site trial enrolled 282 ED patients ≥21 years old with symptoms concerning for ACS, inclusive of all cardiac risk levels. Each patient was classified as low risk or at risk by the EDACS-ADP based on EDACS, electrocardiogram, and serial troponins. Potential early discharge rate and sensitivity for MACE at 30 days, defined as cardiac death, myocardial infarction (MI), or coronary revascularization were calculated.

Results: MACE occurred in 17/282 (6.0%) participants, including no deaths, 16/282 (5.6%) with MI, and 1/282 (0.4%) with coronary revascularization without MI. The EDACS-ADP identified 188/282 patients [66.7%, 95% confidence interval (CI): 60.8%–72.1%] as low risk. Of these, 2/188 (1.1%, 95% CI: 0.1%–3.9%) had MACE at 30 days. EDACS-ADP was 88.2% (95% CI: 63.6%–98.5%) sensitive for MACE, identifying 15/17 patients. Of the 2 patients identified as low risk with MACE, 1 had MI and 1 had coronary revascularization without MI.

Conclusions: Within a US cohort of ED patients with symptoms concerning for ACS, sensitivity for MACE was 88.2%. We are unable to validate the EDACS-ADP as sufficiently sensitive for clinical use.

From the *Department of Emergency Medicine, Division of Cardiology, Department of Internal Medicine, and Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.

Received for publication May 22, 2015; accepted August 17, 2015.

This study was funded by the American Heart Association (12CRP12000001). Dr. Mahler receives funding from the AHA, the Donaghue Foundation via the AAMC, and NHLBI (1 R01 HL118263-01, L30 HL120008).

Reprints: Jason P. Stopyra, MD, Department of Emergency Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157. E-amil:jstopyra@wakehealth.edu.

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