Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 83(13), 1181–1190. https://doi.org/10.1016/j.jacc.2024.02.004 Dr. Simon A. Mahler et al.
Points
- A multisite U.S. cohort study aimed to validate the American College of Cardiology (ACC) Expert Consensus Decision Pathway for chest pain in adults with possible acute coronary syndrome.
- The study utilized ECGs and high-sensitivity troponin measures to stratify patients according to the ACC Pathway, with the primary safety outcome being a 30-day all-cause death or myocardial infarction (MI).
- Among the 14,395 patients assessed, the ACC Pathway demonstrated an efficacy of 48.1%, with a high negative predictive value of 99.7% among patients in the rule-out zone.
- However, caution is advised when applying the pathway to patients with known coronary artery disease (CAD), as only 20.0% of these patients were classified to the rule-out zone, and 1.5% of them experienced death or MI, indicating potential safety concerns for this subgroup.
- The study concluded that while the ACC Expert Consensus Decision Pathway was generally safe and efficacious, its application to patients with known CAD may require careful consideration.
Summary
In a multisite U.S. cohort, an observational study was conducted to validate the American College of Cardiology (ACC) Expert Consensus Decision Pathway for chest pain in adults with possible acute coronary syndrome. The study, which accrued patients from 5 U.S. Emergency Departments from November 1, 2020, to July 31, 2022, utilized ECGs and 0- and 2-hour high-sensitivity troponin measures to stratify patients according to the ACC Pathway. The primary safety outcome assessed was a 30-day all-cause death or myocardial infarction (MI), while efficacy was defined as the proportion stratified to the rule-out zone. The negative predictive value for 30-day death or MI was evaluated among the entire cohort and in a subgroup of patients with coronary artery disease (CAD).
The study’s results revealed that among the 14,395 patients with complete ACC Pathway assessments, 51.7% were women, with a median age of 56 years. Known CAD was present in 23.5% of the cohort, and 30-day death or MI occurred in 8.1% of the patients. The ACC Pathway demonstrated an efficacy of 48.1%, with a negative predictive value of 99.7% among patients in the rule-out zone. However, in patients with known CAD, only 20.0% were classified to the rule-out zone, and 1.5% of these patients experienced death or MI, indicating potential safety concerns for this subgroup.
In conclusion, the study validated the safety and efficacy of the ACC Expert Consensus Decision Pathway for chest pain in a multisite U.S. cohort. However, the findings suggest that caution should be exercised when applying the pathway to patients with known CAD, as this subgroup may not be as safe.
Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S0735109724002559
References Mahler, S. A., Ashburn, N. P., Supples, M. W., Hashemian, T., & Snavely, A. C. (2024). Validation of the ACC Expert Consensus Decision Pathway for Patients With Chest Pain. Journal of the American College of Cardiology, 83(13), 1181–1190. https://doi.org/10.1016/j.jacc.2024.02.004
