title: A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study.
abstract: BACKGROUND
  Patients with chest pain contribute substantially to emergency department attendances, lengthy hospital stay, and inpatient admissions. A reliable, reproducible, and fast process to identify patients presenting with chest pain who have a low short-term risk of a major adverse cardiac event is needed to facilitate early discharge. We aimed to prospectively validate the safety of a predefined 2-h accelerated diagnostic protocol (ADP) to assess patients presenting to the emergency department with chest pain symptoms suggestive of acute coronary syndrome.
  
  
  METHODS
  This observational study was undertaken in 14 emergency departments in nine countries in the Asia-Pacific region, in patients aged 18 years and older with at least 5 min of chest pain. The ADP included use of a structured pre-test probability scoring method (Thrombolysis in Myocardial Infarction [TIMI] score), electrocardiograph, and point-of-care biomarker panel of troponin, creatine kinase MB, and myoglobin. The primary endpoint was major adverse cardiac events within 30 days after initial presentation (including initial hospital attendance). This trial is registered with the Australia-New Zealand Clinical Trials Registry, number ACTRN12609000283279.
  
  
  RESULTS
  3582 consecutive patients were recruited and completed 30-day follow-up. 421 (11.8%) patients had a major adverse cardiac event. The ADP classified 352 (9.8%) patients as low risk and potentially suitable for early discharge. A major adverse cardiac event occurred in three (0.9%) of these patients, giving the ADP a sensitivity of 99.3% (95% CI 97.9-99.8), a negative predictive value of 99.1% (97.3-99.8), and a specificity of 11.0% (10.0-12.2).
  
  
  CONCLUSIONS
  This novel ADP identifies patients at very low risk of a short-term major adverse cardiac event who might be suitable for early discharge. Such an approach could be used to decrease the overall observation periods and admissions for chest pain. The components needed for the implementation of this strategy are widely available. The ADP has the potential to affect health-service delivery worldwide.
  
  
  BACKGROUND
  Alere Medical (all countries), Queensland Emergency Medicine Research Foundation and National Health and Medical Research Council (Australia), Christchurch Cardio-Endocrine Research Group (New Zealand), Medquest Jaya Global (Indonesia), Science International (Hong Kong), Bio Laboratories Pte (Singapore), National Heart Foundation of New Zealand, and Progressive Group (Taiwan).
authors: Christchurch Hospital, Christchurch, New Zealand. martinthan@xtra.co.nz
authors: Martin
authors: M
authors: Than
authors: Louise
authors: L
authors: Cullen
authors: Christopher M
authors: CM
authors: Reid
authors: Swee Han
authors: SH
authors: Lim
authors: Sally
authors: S
authors: Aldous
authors: Michael W
authors: MW
authors: Ardagh
authors: W Frank
authors: WF
authors: Peacock
authors: William A
authors: WA
authors: Parsonage
authors: Hiu Fai
authors: HF
authors: Ho
authors: Hiu Fai
authors: HF
authors: Ko
authors: Ravi R
authors: RR
authors: Kasliwal
authors: Manish
authors: M
authors: Bansal
authors: Sunarya
authors: S
authors: Soerianata
authors: Dayi
authors: D
authors: Hu
authors: Rongjing
authors: R
authors: Ding
authors: Qi
authors: Q
authors: Hua
authors: Kang
authors: K
authors: Seok-Min
authors: Piyamitr
authors: P
authors: Sritara
authors: Ratchanee
authors: R
authors: Sae-Lee
authors: Te-Fa
authors: TF
authors: Chiu
authors: Kuang-Chau
authors: KC
authors: Tsai
authors: Fang-Yeh
authors: FY
authors: Chu
authors: Wei-Kung
authors: WK
authors: Chen
authors: Wen-Han
authors: WH
authors: Chang
authors: Dylan F
authors: DF
authors: Flaws
authors: Peter M
authors: PM
authors: George
authors: A Mark
authors: AM
authors: Richards
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000209:etiology*; D002985:Clinical Protocols; D052279:Creatine Kinase, MB Form / Q000097:blood*; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D009211:Myoglobin / Q000097:blood*; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity; D014218:Triage / Q000379:methods; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D009211:Myoglobin; D014336:Troponin; D052279:Creatine Kinase, MB Form