Received care compared to ADP-guided care of patients admitted to hospital with chest pain of possible cardiac origin

Figures & data

Table 1 ADAPT-ADP score

Criteria
All criteria have to be negative for the ADP to be considered negative and for the patient to be identified as low risk:
1. Serum troponin at 0 and 2 hours below institutional cutoff for an elevated troponin concentration
2. No new ischemic changes on initial ECG in ED
3. TIMI score = 0 where criteria f and g of the TIMI score are redundant on the basis of criteria 1 and 2, where initial serum troponin in ED (at 0 hours) is not elevated and initial ECG shows no ischemic changes, ie, maximum TIMI score =5

Note: Data from Than M, Cullen L, Aldous S, et al. A 2-hour Accelerated Diagnostic Protocol to Assess Patients with Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker: the ADAPT Trial. J Am Coll Cardiol. 2012;59(23):2091–2098.⁹

Abbreviations: ED, emergency department; ECG, electrocardiogram; TIMI, Thrombolysis in Myocardial Infarction; ADP, accelerated diagnostic protocol.

Table 2 Patient characteristics, care processes, and clinical outcomes (n=290)

Characteristics
Age (years)	58.6±14.3
Males	168 (58.0)
Known CAD	67 (23.1)
TypicaI ischemic chest pain	62 (21.3)
Atypical chest pain	228 (78.6)
Hypertension	98 (33.7)
Diabetes mellitus	44 (15.1)
Dyslipidemia	51 (17.5)
Smoking	57 (19.6)
Family history of CAD	35 (12.0)
Use of telemetry beds	121 (41.3)
Length of hospital stay	1.6 (±1.2)
TIMI score	1.8 (±1.7)
Non-invasive testing	112 (38.6)
Non-invasive testing with positive results	4 (1.3)
Coronary angiography	5 (1.7)
Coronary angiography with positive results	4 (1.4)
Confirmed diagnosis of ACS at discharge	6 (2.0)
Major adverse events at 6 months	6 (2.1)
All-cause death	2 (0.7)
Acute coronary syndrome	1 (0.3)
New-onset arrhythmia	2 (0.6)
Heart failure	1 (0.3)
Coronary revascularization at 6 months	1 (0.3)

Note: Results expressed as number (percentage) or mean (±SD).

Abbreviations: CAD, coronary artery disease; ACS, acute coronary syndrome; TIMI, Thrombolysis in Myocardial Infarction.

Figure 1 Investigations performed with results.

Abbreviations: EST, exercise stress ECG; CTCA, computerized tomographic coronary angiography; ESE, exercise echocardiogram; DSE, dobutamine stress echocardiograph; MPS, myocardial perfusion scan; ECG, electrocardiogram.

Table 3 Characteristics of patients who underwent non-invasive testing vs no testing

Characteristics	Non- invasive tests (n=112)	No test (n=178)
Age (years)	57.1 (±12.7)	58.8 (±13.3)
History of CAD	6 (5.3)	51 (28.6)*
Males	69 (61.6)	109 (61.1)
Typical ischemic chest pain	17 (12.7)	24 (13.4)
TIMI score	1.8±1.6	1.7±1.5

Notes: Results expressed as number (percentage) or mean (±SD);

* p<0.05 for comparison of groups.

Abbreviations: CAD, coronary artery disease; TIMI, Thrombolysis in Myocardial Infarction.

Table 4 Clinical characteristics, care processes, and outcomes of patients deemed low risk by accelerated diagnostic protocol compared to non-low-risk patients

Characteristics	Low risk (n=97)	Non-low risk (n=193)
Age (years)	57.4 (±14.2)	59.2 (±14.4)
Male	52 (53.6)	116 (60.1)
Typical ischemic chest pain	16 (16.4)	46 (23.8)
Atypical chest pain	81 (83.6)	147 (76.2)
Use of telemetry beds	39 (40.2)	82 (42.4)
Length of hospital stay	1.5 (±1.1)	1.6 (±1.2)
Non-invasive testing	21 (21.6)	91 (47.2)*
Non-invasive testing with positive results	1 (1.0)	3 (1.6)
Coronary angiography	0 (0)	5 (2.6)
Coronary angiography with positive results	0 (0)	4 (2.1)
Confirmed diagnosis of ACS at discharge	0 (0)	6 (3.1)
In-hospital coronary revascularization	0 (0)	1 (0.5)
Major adverse cardiac events at 6 months	0 (0)	6 (3.1)
Coronary revascularization at 6 months	0 (0)	1 (0.5)

Notes: Results expressed as number (percentage) or mean (±SD);

* p<0.05 for comparison between groups.

Abbreviation: ACS, acute coronary syndrome.

ThanMCullenLAldousSA 2-hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT TrialJ Am Coll Cardiol201259232091209822578923

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