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World Journal of Emergency Medicine ›› 2024, Vol. 15 ›› Issue (3): 175-180.doi: 10.5847/wjem.j.1920-8642.2024.032

• Original Articles • Previous Articles     Next Articles

Performance of the EDACS-ADP incorporating high-sensitivity troponin assay: Do components of major adverse cardiac events matter?

Yedalm Yoo, Shin Ahn(), Bora Chae, Won Young Kim   

  1. Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
  • Received:2023-06-20 Accepted:2023-11-16 Online:2024-05-15 Published:2024-05-01
  • Contact: Shin Ahn, Email:


BACKGROUND: The accelerated diagnostic protocol (ADP) using the Emergency Department Assessment of Chest pain Score (EDACS-ADP), a tool to identify patients at low risk of a major adverse cardiac event (MACE) among patients presenting with chest pain to the emergency department, was developed using a contemporary troponin assay. This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina (MACE I and II, respectively).
METHODS: A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed. The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value.
RESULTS: Of the 1,304 patients prospectively enrolled, 399 (30.6%; 95% confidence interval [95% CI]: 27.7%-33.8%) were considered low-risk using the EDACS-ADP. Among them, the rates of MACE I and II were 1.3% (5/399) and 1.0% (4/399), respectively. The EDACS-ADP showed sensitivities and negative predictive values of 98.8% (95% CI: 97.2%-99.6%) and 98.7% (95% CI: 97.0%-99.5%) for MACE I and 98.7% (95% CI: 96.8%-99.7%) and 99.0% (95% CI: 97.4%-99.6%) for MACE II, respectively.
CONCLUSION: EDACS-ADP could help identify patients as safe for early discharge. However, when unstable angina was added to the outcome, the 30-day MACE rate among the designated low-risk patients remained above the level acceptable for early discharge without further evaluation.

Key words: Chest pain, Major adverse cardiac event, Acute coronary syndrome, Emergency department