title: Performance of risk stratification for acute coronary syndrome with two-hour sensitive troponin assay results.
abstract: BACKGROUND
  Risk stratification processes for patients with possible acute coronary syndrome (ACS) recommend the use of serial sensitive troponin testing over at least 6h. Troponin assays vary in their analytical performance. Utility in accurate risk stratification at 2h post-presentation is unknown.
  
  
  METHODS
  A diagnostic accuracy study of patients presenting to the emergency department (ED) with symptoms of ACS was performed. Troponin was measured at 0, 2 and 6h post-presentation. Acute myocardial infarction (AMI) was adjudicated by cardiologists and incorporated the 0 and 6h troponin values measured by a sensitive troponin assay. Results were described using standard measures of test accuracy.
  
  
  RESULTS
  Of the 685 patients, 51 (7.4%) had 30-day AMI or cardiac death, and 76 (11.1%) had secondary outcomes (all cause death, ACS and revascularisation procedures). There was no significant difference in the diagnostic accuracy of early versus late biomarker strategies when used with the current risk stratification processes. Incorporation of a significant delta did not improve the stratification at 2h post-presentation.
  
  
  CONCLUSIONS
  Accelerated risk stratification of patients with ACS symptoms may occur at 2h post-presentation using troponin results measured by a sensitive assay. Incorporation of such a strategy could support improvements in patient flow within EDs.
authors: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Public Health, Queensland University of Technology, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia. Electronic address: louise_cullen@health.qld.gov.au.
authors: Louise
authors: L
authors: Cullen
authors: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Public Health, Queensland University of Technology, Brisbane, Australia.
authors: Jaimi
authors: J
authors: Greenslade
authors: Department of Emergency Medicine, Christchurch Hospital, New Zealand.
authors: Martin
authors: M
authors: Than
authors: Pathology Queensland, Brisbane, Australia.
authors: Jillian
authors: J
authors: Tate
authors: Pathology Queensland, Brisbane, Australia.
authors: Jacobus P J
authors: JP
authors: Ungerer
authors: Pathology Queensland, Brisbane, Australia.
authors: Carel
authors: C
authors: Pretorius
authors: School of Medicine, The University of Queensland, Brisbane, Australia; Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors: Christopher J
authors: CJ
authors: Hammett
authors: Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors: Arvin
authors: A
authors: Lamanna
authors: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia.
authors: Kevin
authors: K
authors: Chu
authors: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia.
authors: Anthony F T
authors: AF
authors: Brown
authors: School of Medicine, The University of Queensland, Brisbane, Australia; Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors: William A
authors: WA
authors: Parsonage
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000401:mortality; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality; D011446:Prospective Studies; D012308:Risk Management; D013997:Time Factors; D014336:Troponin / Q000097:blood*
chemical_list: D014336:Troponin
keywords: Acute coronary syndrome; Emergency Service; Hospital; Risk stratification; Troponin