Does this patient with chest pain have acute coronary syndrome?: The rational clinical examination systematic review

JAMA - Journal of the American Medical Association

Volumn 314, Issue 18, 2015, Pages 1955-1965

  Fanaroff, Alexander C ^a,b   Rymer, Jennifer A ^a,b   Goldstein, Sarah A ^b   Simel, David L ^c   Newby, L Kristin ^a,b,d  

^a DUKE UNIVERSITY MEDICAL CENTER   (United States)

^b DUKE UNIVERSITY SCHOOL OF MEDICINE   (United States)

^c DURHAM VA MEDICAL CENTER   (United States)

^d DUKE CLINICAL RESEARCH INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

TROPONIN;

ACUTE CORONARY SYNDROME; ARM PAIN; CARDIOVASCULAR DISEASE; CARDIOVASCULAR DISEASE ASSESSMENT; CARDIOVASCULAR RISK; CLINICAL EXAMINATION; DIAGNOSTIC ACCURACY; DIAGNOSTIC TEST ACCURACY STUDY; ELECTROCARDIOGRAPHY; HEART SCORE; HUMAN; ISCHEMIA; MEDICAL HISTORY; PERIPHERAL OCCLUSIVE ARTERY DISEASE; PHYSICAL EXAMINATION; PRIORITY JOURNAL; REVIEW; SENSITIVITY AND SPECIFICITY; SYMPTOM ASSESSMENT; SYSTEMATIC REVIEW; THORAX PAIN; THROMBOLYSIS IN MYOCARDIAL INFARCTION RISK SCORE; CHEST PAIN; COMPLICATION; PROBABILITY; RISK FACTOR;

ACUTE CORONARY SYNDROME; CHEST PAIN; ELECTROCARDIOGRAPHY; HUMANS; PHYSICAL EXAMINATION; PROBABILITY; RISK FACTORS; SENSITIVITY AND SPECIFICITY;

EID: 84946761099     PISSN: 00987484     EISSN: 15383598     Source Type: Journal    
DOI: 10.1001/jama.2015.12735     Document Type: Review

References (85)

1. Amsterdam EA, Kirk JD, Bluemke DA, et al; American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology, Council on Cardiovascular Nursing, and Interdisciplinary Council on Quality of Care and Outcomes Research. Testing of low-risk patients presenting to the emergency department with chest pain: A scientific statement from the American Heart Association. Circulation. 2010;122(17):1756-1776.
2. Penumetsa SC, Mallidi J, Friderici JL, HiserW, Rothberg MB. Outcomes of patients admitted for observation of chest pain. Arch Intern Med. 2012; 172(11):873-877.
3. Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342 (16):1163-1170.
4. Than M, HerbertM, Flaws D, et al. What is an acceptable risk of major adverse cardiac event in chest pain patients soon after discharge from the emergency department?: A clinical survey. Int J Cardiol. 2013;166(3):752-754.
5. Mitchell AM, Garvey JL, Chandra A, Diercks D, Pollack CV, Kline JA. Prospective multicenter study of quantitative pretest probability assessment to exclude acute coronary syndrome for patients evaluated in emergency department chest pain units. Ann Emerg Med. 2006;47(5):447.
6. Høilund-Carlsen PF, Johansen A, VachW, Christensen HW, Møldrup M, Haghfelt T. High probability of disease in angina pectoris patients: is clinical estimation reliable? Can J Cardiol. 2007;23 (8):641-647.
7. Panju AA, Hemmelgarn BR, Guyatt GH, Simel DL. The rational clinical examination: is this patient having amyocardial infarction? JAMA. 1998;280 (14):1256-1263.
8. O'Gara PT, Kushner FG, Ascheim DD, et al; American College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions. 2013 ACCF/AHA guideline for the management of ST-elevationmyocardial infarction: A report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines. J AmColl Cardiol. 2013;61(4):e78-e140.
9. Hamm CW, Bassand J-P, Agewall S, et al; ESC Committee for Practice Guidelines. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The task force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(23):2999-3054.
10. Amsterdam EA,Wenger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64 (24):e139-e228.
11. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition ofmyocardial infarction. J Am Coll Cardiol. 2012;60(16):1581-1598.
12. Cullen L, Than M, Brown AF, et al. Comprehensive standardized data definitions for acute coronary syndrome research in emergency departments in Australasia. Emerg Med Australas. 2010;22(1):35-55.
13. Kelly AM, Klim S. What is the 30-day rate of adverse cardiac events in chest pain patients with ED troponin I assays 99th centile using a contemporary sensitive assay? an exploratory analysis. Eur J Emerg Med. 2014;21(4):276-280.
14. Simel DL, Rennie D. A Primer on the Precision and Accuracy of the Clinical Examination. In: Simel DL, Rennie D, eds. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. New York, NY: McGraw-Hill; 2009.
15. Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: A tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med ResMethodol. 2003;3:25.
16. Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation myocardial infarction: amethod for prognostication and therapeutic decision making. JAMA. 2000;284 (7):835-842.
17. Backus BE, Six AJ, Kelder JC, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013;168(3):2153-2158.
18. Fesmire FM, Martin EJ, Cao Y, Heath GW. Improving risk stratification in patients with chest pain: The Erlanger HEARTS3 score. Am J Emerg Med. 2012;30(9):1829-1837.
19. Jellema LJ, Backus BE, Six AJ, et al. The value of clinical and laboratory diagnostics for chest pain patients at the emergency department. Clin Chem Lab Med. 2014;52(2):259-266.
20. Marcoon S, Chang AM, Lee B, Salhi R, Hollander JE. HEART score to further risk stratify patients with low TIMI scores. Crit Pathw Cardiol. 2013;12(1):1-5.
21. Melki D, Jernberg T. HEART score: A simple and useful tool that may lower the proportion of chest pain patients who are admitted. Crit Pathw Cardiol. 2013;12(3):127-131.
22. Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008;16(6):191-196.
23. Six AJ, Cullen L, Backus BE, et al. The HEART score for the assessment of patients with chest pain in the emergency department: A multinational validation study. Crit Pathw Cardiol. 2013;12(3):121-126.
24. Boersma E, Pieper KS, Steyerberg EW, et al; The PURSUIT Investigators. Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation: results from an international trial of 9461 patients. Circulation. 2000;101(22):2557-2567.
25. Sanders S, Flaws D, Than M, Pickering JW, Doust J, Glasziou P. Simplification of a scoring system maintained overall accuracy but decreased the proportion classified as low risk [published onlineMay 14, 2015]. J Clin Epidemiol. 2015; S0895-4356(15)00227-9.
26. Higgins JP, Thompson SG. Quantifying heterogeneity in ameta-analysis. Stat Med. 2002; 21(11):1539-1558.
27. Borenstein MHL, Higgins JPT, Rothstein HR. Introduction toMeta-analysis. Chichester, United Kingdom: John Wiley & Sons; 2009.
28. Aldous SJ, Richards M, Cullen L, Troughton R, Than M. A 2-hour thrombolysis inmyocardial infarction score outperforms other risk stratification tools in patients presenting with possible acute coronary syndromes: comparison of chest pain risk stratification tools. Am Heart J. 2012; 164(4):516-523.
29. Aldous SJ, Richards MA, Cullen L, Troughton R, Than M. A new improved accelerated diagnostic protocol safely identifies low-risk patients with chest pain in the emergency department. Acad Emerg Med. 2012;19(5):510-516.
30. Backus BE, Six AJ, Kelder JC, et al. Chest pain in the emergency room: A multicenter validation of the HEART Score. Crit Pathw Cardiol. 2010;9(3): 164-169.
31. Björk J, Forberg JL, Ohlsson M, Edenbrandt L, Ohlin H, Ekelund U. A simple statistical model for prediction of acute coronary syndrome in chest pain patients in the emergency department. BMC Med Inform Decis Mak. 2006;6:28.
32. Body R, Carley S, McDowell G, Ferguson J, Mackway-Jones K. Can a modified thrombolysis in myocardial infarction risk score outperform the original for risk stratifying emergency department patients with chest pain? Emerg Med J. 2009;26 (2):95-99.
33. Burkett E, Marwick T, Thom O, Kelly AM. A comparative analysis of risk stratification tools for emergency department patients with chest pain. Int J Emerg Med. 2014;7(1):10.
34. Campbell CF, Chang AM, Sease KL, et al. Combining Thrombolysis inMyocardial Infarction risk score and clear-cut alternative diagnosis for chest pain risk stratification. Am J Emerg Med. 2009;27(1):37-42.
35. Chang AM, Shofer FS, Tabas JA,Magid DJ, McCusker CM, Hollander JE. Lack of association between left bundle-branch block and acute myocardial infarction in symptomatic emergency department patients. Am J Emerg Med. 2009;27 (8):916-921.
36. Chase M, Robey JL, Zogby KE, Sease KL, Shofer FS, Hollander JE. Prospective validation of the Thrombolysis in Myocardial Infarction risk score in the emergency department chest pain population. Ann Emerg Med. 2006;48(3):252-259.
37. Christenson J, Innes G, McKnight D, et al. A clinical prediction rule for early discharge of patients with chest pain. Ann Emerg Med. 2006;47 (1):1-10.
38. Cullen L, Greenslade J, Hammett CJ, et al. Comparison of 3 risk stratification rules for predicting patients with acute coronary syndrome presenting to an Australian emergency department. Heart Lung Circ. 2013;22(10):844-851.
39. Cullen L, Mueller C, ParsonageWA, et al. Validation of high-sensitivity troponin I in a 2-hour diagnostic strategy to assess 30-day outcomes in emergency department patients with possible acute coronary syndrome. J AmColl Cardiol. 2013; 62(14):1242-1249.
40. Diercks DB, Boghos E, Guzman H, Amsterdam EA, Kirk JD. Changes in the numeric descriptive scale for pain after sublingual nitroglycerin do not predict cardiac etiology of chest pain. Ann Emerg Med. 2005;45(6):581-585.
41. Dooley J, Chang AM, A Salhi R, Hollander JE. Relationship between body mass index and prognosis of patients presenting with potential acute coronary syndromes. Acad Emerg Med. 2013; 20(9):904-910.
42. Edwards M, Chang AM, Matsuura AC, Green M, Robey JM, Hollander JE. Relationship between pain severity and outcomes in patients presenting with potential acute coronary syndromes. Ann Emerg Med. 2011;58(6):501-507.
43. Farkouh ME, Aneja A, Reeder GS, et al. Clinical risk stratification in the emergency department predicts long-term cardiovascular outcomes in a population-based cohort presenting with acute chest pain: primary results of the Olmsted county chest pain study. Medicine (Baltimore). 2009;88 (5):307-313.
44. Fermann GJ, Lindsell CJ, O'Neil BJ, Gibler WB. Performance of a body surface mapping system using emergency physician real-time interpretation. Am J Emerg Med. 2009;27(7):816-822.
45. Forest RS, Shofer FS, Sease KL, Hollander JE. Assessment of the standardized reporting guidelines ECG classification system: The presenting ECG predicts 30-day outcomes. Ann Emerg Med. 2004;44(3):206-212.
46. Graham CA, Tsay SX, Rotheray KR, Rainer TH. Validation of the TIMI risk score in Chinese patients presenting to the emergency department with chest pain. Int J Cardiol. 2013;168(1):597-598.
47. Han JH, Lindsell CJ, Hornung RW, et al. The elder patient with suspected acute coronary syndromes in the emergency department. Acad Emerg Med. 2007;14(8):732-739.
48. Henrikson CA, Howell EE, Bush DE, et al. Chest pain relief by nitroglycerin does not predict active coronary artery disease. Ann Intern Med. 2003;139 (12):979-986.
49. Hess EP, Brison RJ, Perry JJ, et al. Development of a clinical prediction rule for 30-day cardiac events in emergency department patients with chest pain and possible acute coronary syndrome. Ann Emerg Med. 2012;59(2):115-125.e1.
50. Hess EP, Perry JJ, Calder LA, et al. Prospective validation of a modified thrombolysis inmyocardial infarction risk score in emergency department patients with chest pain and possible acute coronary syndrome. Acad Emerg Med. 2010;17(4): 368-375.
51. Ilgen JS, Manini AF, Hoffmann U, et al. Prognostic utility of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI). Int J Emerg Med. 2011;4(1):49.
52. Jaffery Z, Hudson MP, Jacobsen G, Nowak R, McCord J. Modified thrombolysis inmyocardial infarction (TIMI) risk score to risk stratify patients in the emergency department with possible acute coronary syndrome. J Thromb Thrombolysis. 2007; 24(2):137-144.
53. Kelly AM. How useful are the Heart Foundation risk criteria for assessment of emergency department patients with chest pain? Emerg Med Australas. 2012;24(3):260-265.
54. Kwong RY, Schussheim AE, Rekhraj S, et al. Detecting acute coronary syndrome in the emergency department with cardiac magnetic resonance imaging. Circulation. 2003;107(4):531-537.
55. Lee B, Chang AM, Matsuura AC, Marcoon S, Hollander JE. Comparison of cardiac risk scores in emergency department patients with potential acute coronary syndrome. Crit Pathw Cardiol. 2011; 10(2):64-68.
56. Lyon R, Morris AC, Caesar D, Gray S, Gray A. Chest pain presenting to the emergency department-to stratify risk with GRACE or TIMI? Resuscitation. 2007;74(1):90-93.
57. Macdonald SP, Nagree Y, Fatovich DM, Brown SG. Modified TIMI risk score cannot be used to identify low-risk chest pain in the emergency department: A multicentre validation study. Emerg Med J. 2014;31(4):281-285.
58. Macdonald SP, Nagree Y, Fatovich DM, Flavell HL, Loutsky F. Comparison of 2 clinical scoring systems for emergency department risk stratification of suspected acute coronary syndrome. EmergMed Australas. 2011;23(6):717-725.
59. Mahler SA,Miller CD, Hollander JE, et al. Identifying patients for early discharge: performance of decision rules among patients with acute chest pain. Int J Cardiol. 2013;168(2):795-802.
60. Milner KA, Funk M, Richards S, Vaccarino V, Krumholz HM. Symptom predictors of acute coronary syndromes in younger and older patients. Nurs Res. 2001;50(4):233-241.
61. Nerenberg RH, Shofer FS, Robey JL, Brown AM, Hollander JE. Impact of a negative prior stress test on emergency physician disposition decision in emergency department patients with chest pain syndromes. Am J Emerg Med. 2007;25(1):39-44.
62. Ngako A, Santin A, Hémery F, et al. Prediction ofmyocardial infarction risk in older patients with acute coronary syndrome. Am J Emerg Med. 2009; 27(6):675-682.
63. ParsonageWA, Greenslade JH, Hammett CJ, et al. Validation of an accelerated high-sensitivity troponin T assay protocol in an Australian cohort with chest pain. Med J Aust. 2014;200(3):161-165.
64. Pelliccia F, Salvini P, Cartoni D, et al. Frequency and clinical correlates of changes in Thrombolysis In Myocardial Infarction risk score during observation period at emergency department in "low-risk" patients with acute chest pain. Am J Cardiol. 2006; 97(6):781-784.
65. Pollack CV Jr, Sites FD, Shofer FS, Sease KL, Hollander JE. Application of the TIMI risk score for unstable angina and non-ST elevation acute coronary syndrome to an unselected emergency department chest pain population. Acad Emerg Med. 2006;13(1):13-18.
66. Shry EA, Dacus J, Van De Graaff E, HjelkremM, Stajduhar KC, Steinhubl SR. Usefulness of the response to sublingual nitroglycerin as a predictor of ischemic chest pain in the emergency department. Am J Cardiol. 2002;90(11):1264-1266.
67. Than M, Cullen L, Aldous S, et al. 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: The ADAPT trial. J AmColl Cardiol. 2012;59(23):2091-2098.
68. Than M, Cullen L, Reid CM, et al. A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): A prospective observational validation study. Lancet. 2011;377(9771):1077-1084.
69. Tong KL, Kaul S,Wang XQ, et al. Myocardial contrast echocardiography versus Thrombolysis In Myocardial Infarction score in patients presenting to the emergency department with chest pain and a nondiagnostic electrocardiogram. J AmColl Cardiol. 2005;46(5):920-927.
70. Liu N, Lee MAB, Ho AFW, et al. Risk stratification for prediction of adverse coronary events in emergency department chest pain patients with a machine learning score compared with the TIMI score. Int J Cardiol. 2014;177(3):1095-1097.
71. Biener M, MuellerM, VafaieM, Katus HA, Giannitsis E. Impact of leading presenting symptoms on the diagnostic performance of high-sensitivity cardiac troponin T and on outcomes in patients with suspected acute coronary syndrome. Clin Chem. 2015;61(5):744-751.
72. Body R, Cook G, Burrows G, Carley S, Lewis PS. Can emergency physicians "rule in" and "rule out" acutemyocardial infarction with clinical judgement? Emerg Med J. 2014;31(11):872-876.
73. van der Meer MG, Backus BE, van der Graaf Y, et al. The diagnostic value of clinical symptoms in women and men presenting with chest pain at the emergency department, a prospective cohort study. PLoS One. 2015;10(1):e0116431.
74. Taylor BT, Mancini M. Discrepancy between clinician and research assistant in TIMI score calculation (TRIAGED CPU).West J Emerg Med. 2015;16(1):24-33.
75. Bhuiya FA, Pitts SR,McCaig LF. Emergency department visits for chest pain and abdominal pain: United States, 1999-2008. NCHS Data Brief. 2010;(43):1-8.
76. Acute Coronary Syndrome GuidelinesWorking Group. Guidelines for the management of acute coronary syndromes 2006. Med J Aust. 2006;184 (8)(suppl):S9-S29.
77. Goldman L, Cook EF, Johnson PA, Brand DA, Rouan GW, Lee TH. Prediction of the need for intensive care in patients who come to the emergency departments with acute chest pain. N Engl J Med. 1996;334(23):1498-1504.
78. Storrow AB, Nowak RM, Diercks DB, et al. Absolute and relative changes (delta) in troponin I for early diagnosis ofmyocardial infarction: results of a prospective multicenter trial. Clin Biochem. 2015;48(4-5):260-267.
79. Kelly AM, Klim S. Does undetectable troponin I at presentation using a contemporary sensitive assay rule outmyocardial infarction? a cohort study. Emerg Med J. 2014;32(10):760-763.
80. Reichlin T, Twerenbold R,Wildi K, et al. Prospective validation of a 1-hour algorithm to rule-out and rule-in acutemyocardial infarction using a high-sensitivity cardiac troponin T assay. CMAJ. 2015;187(8):E243-E252.
81. Bandstein N, Ljung R, Johansson M, Holzmann MJ. Undetectable high-sensitivity cardiac troponin T level in the emergency department and risk of myocardial infarction. J AmColl Cardiol. 2014;63 (23):2569-2578.
82. Marini MG, Cardillo MT, Caroli A, Sonnino C, Biasucci LM. Increasing specificity of high-sensitivity troponin: new approaches and perspectives in the diagnosis of acute coronary syndromes. J Cardiol. 2013;62(4):205-209.
83. Bossuyt PM, Davenport C, Keeks J, Hyde C, Leeflang M, Scholten R. Interpreting results and drawing conclusions. In: Deeks JJBP, Gatsonis C, eds. Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy, Version 0.9. London, United Kingdom: The Cochrane Collaboration; 2013:chap 11.
84. Mahler SA, Riley RF, Hiestand BC, et al. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes. 2015;8(2):195-203.
85. Than M, Flaws D, Sanders S, et al. Development and validation of the Emergency Department Assessment of Chest Pain score and 2-h accelerated diagnostic protocol. Emerg Med Australas. 2014;26 (1):34-44.