CC Sept Algorithm for ACS

echoecho's version from 2015-09-24 12:27


Question Answer
What is the leading cause of death in the US?cardiovascular disease
In the recent years, there has been an improvement in the ability to rapidly detect ACS, also what other treatments have led to improvement in morbidity and mortality?advances in medical, procedural and surgical treatment
Do the majority of pts present to the ER with CP have ACS?no
Because the costs of detecting ACS (overnight stay and serial cardiac enzymes are substantial, what has been attempted to reduce cost but not sacrific accuracy?an expedited algorithm to r/o ACS
How many hours after myocardial damage does levels of cardiac troponin rise?6 hours
What cardiac troponin assay has been developed?a highly sensitive cardiac troponin assay
Describe 2 facts on how the highly sensitive cardiac troponin assay differs from the regular troponin assay?1) the highly sensitive cardiac troponin assay measures even low concentrations of troponin within the FIRST hour after myocardial damage 2)rather than an all-or-none phenomenon (a pt is either troponin-positive or troponin-negative), the use of the highly-sensitive assay allows for a gradation of values where higher concentrations have a higher association with myocardial damage and absolute value changes over 1 hour are reliable surrogates for changes seen after 6 hours
In 2015, a trial evaluated the highly sensitive troponin assay 1 hour algorithm (involving a value at baseline and a value in 1 hour). Final dx was determed by 2 cardiologist and included review of all available information like serial troponin levels and results of diagnostic tests. What was the findings for this 1 hour algorithm?1. Patients were classified as r/o (59.5%), rule-in (16.4%) or observational zone (24.1%). R/o pts had an initial highly-sensitive troponin value of < 12 ng/L and an absolute change within the first hour of < 3 ng/L while rule in pts had an initial value of > 52 ng/L or an absolute change of > 5 ng/L w/in the first hour, while pts who did not fall into either category were classified as an observation group.
For the 1 hour algorithm, what was the negative predictive value in the rule-out group? What was the positive predictive value in the rule-in group?99.9%; 78.2%
*** The 1-hour algorithm had a _______ (higher vs. lower) negative and positive predictive value than the standard troponin interpretation using a single value cut-off?higher
For the 1-hour algorithm, what was the 30 day mortality in the r/o group; in the observation group and the rule-in group?0%; 1.6%; 1.9%
In 2015, a 2-hour highly sensitive troponin assay was evaluated in 1148 pts presents to the ER with suspected AMI. What was the positive predictive value of the rule-in group (16% of pts)? What was the negative predictive value of the r/o group (60% of pts)?78%; 99.9%
For this 2 hour highly sensitive troponin assay, what was the 30 day survival rates for the r/o group? for the rule-in group? for the observation group?100%; 95.2%; 98.9%
Taken together, these above studies suggest that pts presenting with CP may be evaluted with a 1 or 2 hour highly-sensitive troponin assay that will accurately predict the presence or absence of myocardial damage in ___ to ___% patients?75-80%