Early discharging patients with chest pain using EDACS-ADP and COMPASS-MI risk predictors

Abstract

Deciding on the early discharge of low-risk patients with chest pain is still controversial in emergency care. Beyond the validated tools for risk assessment, high sensitive troponin levels on admission, whether to take the next serial sampling or when to take are the main issues affecting the unnecessary follow-ups that lead to the emergency crowd. We aimed to investigate the prediction performance of emergency department assessment of chest pain score and accelerated diagnostic protocol (EDACS-ADP) and calculation of MI risk probabilities to manage patients with suspicion of myocardial infarction (COMPASS-MI). We conducted a prospective cross-sectional study that included patients with chest pain followed-up in the emergency department with a serial troponin sampling. We calculated the performance tests of the risk scores after recording the patients' risk factors, chest pain types, troponin levels as defined in the risk assessment tools. Nine hundred eleven patients were included in the study. Thirty-eight patients had significant adverse cardiovascular events (MACE) within 30 days. Patients with a not-low-risk score at EDACS-ADP had a 3.975 (95% CI 2.136-7.396) fold higher risk of MACE than the patients with low-risk EDACS-ADP, and the absolute risk increase was 7.3%. Patients with high-risk late-stage risk in COMPASS-MI had a 3.581 (95% CI 1.660-7.726) fold higher risk of MACE than those with low-risk late-stage risk in COMPASS-MI, and absolute risk increase was 4.6%. We found EDACS-ADP and COMPASS-MI at a late time point (2 h hsTnI) with a high negative predictive value as a risk assessment tool for discharging chest pain patients.