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Discrimination and High Sensitivity Cardiac Troponin: The Interrelationship Between Clinical Presentation, Clinician Request and Discharge Diagnosis
S36
Heart, Lung and Circulation 2012;21:S1–S142
CSANZ 2012 Abstracts
ABSTRACTS
algorithm allowed 92.3% of patients to be classified as high or low risk for AMI at 2 h. Conclusions: A 2-h algorithm incorporating absolute cut-off and delta cTn values with a sensitive troponin assay allowed the accurate diagnosis of AMI within two hours from presentation, supporting accelerated assessment for majority of ED patients. http://dx.doi.org/10.1016/j.hlc.2012.05.094 85 Discrimination and High Sensitivity Cardiac Troponin: The Interrelationship Between Clinical Presentation, Clinician Request and Discharge Diagnosis G. Paull 1,∗ , R. Gallagher 2 , R. Horvath 3 , D. Chen 1 1 St.George
Hospital, Sydney, Australia of Technology, Sydney, Australia 3 South Eastern Area Laboratory Service, Prince of Wales Hospital, Sydney, Australia 2 University
Background: High sensitivity cardiac troponin (hscTnT) is the recommended cardiac biomarker in evaluating suspected acute coronary syndrome (ACS). The reduced specificity of the assay has led to recommendations relating to clinical indication and assessment. Aim: To evaluate the clinical requests for hs-cTnT assay at a tertiary referral centre in context of clinical presentation, comorbidity burden and discharge diagnosis. Method: Retrospective audit conducted on all patients (n = 237) with hs-cTnT assay performed during a twoweek period. Data collected included presentation history, hsc-TnT testing sequence and results, pre-test probability and presence of known non coronary disease causes of hsc-TnT elevation. Independent predictors of ACS were determined using regression analysis. Results: Mean age 68.86 years with 56% female. 41% had a clinical indication of ACS, 79% ≥ 1 coronary heart disease risk factor. Neither factor was present in 14% of cases. 51% of patients had a baseline hs-cTnT ≥ 14 ng/L and 8% ≥ 100 ng/L. 11% had an ACS diagnosis at discharge. 66% of patients with hs-cTnT ≥ 14 ng/L had a repeat test and 53% of those with hs-cTnT ≥ 100 g/L. 45% were retested within 6–7 h. The likelihood of ACS diagnosis at discharge was increased by hs-cTnT delta-change ≥30% increase, hs-cTnT >100 ng/L and ACS symptoms and decreased by female gender. Conclusion: Hs-cTnT is frequently requested in the absence of clinical indication. Male gender, presence of ACS symptoms, elevated first hs-cTnT level > 14 ng/L and hs-cTnT > 100 ng/L were independent predictors of ACS at discharge. http://dx.doi.org/10.1016/j.hlc.2012.05.095
86 Do Acute Coronary Syndrome Patients Categorised at High Risk by GRACE Receive more Frequent and Earlier Coronary Angiography? A. Lin 1 , A. Mustafa 1 , G. McLachlan 1 , A. Kerr 1
Devlin 2,∗ , M.
Lee 1 , A.
1 Middlemore 2 Waikato
Hospital, New Zealand Hospital, New Zealand
Background: The ESC recommends that Acute Coronary Syndrome (ACS) identified as high risk using the GRACE score undergo coronary angiography within 24 h. Our aim was to study how coronary investigation and management relate to risk in three New Zealand hospitals where GRACE is not routinely used. Method: Consecutive cohorts admitted to Middlemore, Taranaki and Waikato Hospitals with suspected ACS between August 2007 and August 2010 were recorded using the Acute Predict database. Patients (pts) were categorised low (<3%), intermediate (3–8%), and high risk (>8%) based on the GRACE admission-to-six month mortality score. Results: Of 3666 pts, 34%, 38% and 28% were low, intermediate and high risk, respectively. Europeans were more likely to be high risk than Maori, Pacific or Indians (32% vs 16%, 20%, and 20%, respectively). High risk pts were older, more likely to be women and to present with heart failure, impaired LV systolic function and severe coronary artery disease. However, high risk pts were less likely than low risk to receive coronary angiography (58 vs 83%, p < .001) and revascularisation (43 vs 58%, p < .001). The median time to angiogram was three days for all three risk groups, with no difference according to risk category at any centre. Conclusion: ACS pts categorised at high risk by GRACE score were least likely to receive coronary angiography and revascularisation, and were not prioritised ahead of lower risk pts. Routine use of a risk score to guide timing of coronary angiography post-ACS should be considered. http://dx.doi.org/10.1016/j.hlc.2012.05.096 87 Does Age Change the Effect of Depressive Symptoms on Mortality in Patients with Coronary Heart Disease? P. Miller ∗ , K. Dracup University of California, San Francisco, United States Background: Depression in patients with coronary heart disease (CHD) is common and associated with mortality. Given limited research, we aimed to determine whether depressive symptoms predict two-year all-cause mortality (ACM) among younger and older age groups diagnosed with CHD. Methods: In a secondary analysis of a longitudinal randomised controlled trial, 3454 CHD patients living in Australia, New Zealand and the United States were assessed at baseline for depressive symptoms using the Multiple Adjective Affect Checklist-D and followed for 2-years. Patients were categorised by age in decades.
Heart, Lung and Circulation 2012;21:S1–S142
CSANZ 2012 Abstracts
ABSTRACTS
algorithm allowed 92.3% of patients to be classified as high or low risk for AMI at 2 h. Conclusions: A 2-h algorithm incorporating absolute cut-off and delta cTn values with a sensitive troponin assay allowed the accurate diagnosis of AMI within two hours from presentation, supporting accelerated assessment for majority of ED patients. http://dx.doi.org/10.1016/j.hlc.2012.05.094 85 Discrimination and High Sensitivity Cardiac Troponin: The Interrelationship Between Clinical Presentation, Clinician Request and Discharge Diagnosis G. Paull 1,∗ , R. Gallagher 2 , R. Horvath 3 , D. Chen 1 1 St.George
Hospital, Sydney, Australia of Technology, Sydney, Australia 3 South Eastern Area Laboratory Service, Prince of Wales Hospital, Sydney, Australia 2 University
Background: High sensitivity cardiac troponin (hscTnT) is the recommended cardiac biomarker in evaluating suspected acute coronary syndrome (ACS). The reduced specificity of the assay has led to recommendations relating to clinical indication and assessment. Aim: To evaluate the clinical requests for hs-cTnT assay at a tertiary referral centre in context of clinical presentation, comorbidity burden and discharge diagnosis. Method: Retrospective audit conducted on all patients (n = 237) with hs-cTnT assay performed during a twoweek period. Data collected included presentation history, hsc-TnT testing sequence and results, pre-test probability and presence of known non coronary disease causes of hsc-TnT elevation. Independent predictors of ACS were determined using regression analysis. Results: Mean age 68.86 years with 56% female. 41% had a clinical indication of ACS, 79% ≥ 1 coronary heart disease risk factor. Neither factor was present in 14% of cases. 51% of patients had a baseline hs-cTnT ≥ 14 ng/L and 8% ≥ 100 ng/L. 11% had an ACS diagnosis at discharge. 66% of patients with hs-cTnT ≥ 14 ng/L had a repeat test and 53% of those with hs-cTnT ≥ 100 g/L. 45% were retested within 6–7 h. The likelihood of ACS diagnosis at discharge was increased by hs-cTnT delta-change ≥30% increase, hs-cTnT >100 ng/L and ACS symptoms and decreased by female gender. Conclusion: Hs-cTnT is frequently requested in the absence of clinical indication. Male gender, presence of ACS symptoms, elevated first hs-cTnT level > 14 ng/L and hs-cTnT > 100 ng/L were independent predictors of ACS at discharge. http://dx.doi.org/10.1016/j.hlc.2012.05.095
86 Do Acute Coronary Syndrome Patients Categorised at High Risk by GRACE Receive more Frequent and Earlier Coronary Angiography? A. Lin 1 , A. Mustafa 1 , G. McLachlan 1 , A. Kerr 1
Devlin 2,∗ , M.
Lee 1 , A.
1 Middlemore 2 Waikato
Hospital, New Zealand Hospital, New Zealand
Background: The ESC recommends that Acute Coronary Syndrome (ACS) identified as high risk using the GRACE score undergo coronary angiography within 24 h. Our aim was to study how coronary investigation and management relate to risk in three New Zealand hospitals where GRACE is not routinely used. Method: Consecutive cohorts admitted to Middlemore, Taranaki and Waikato Hospitals with suspected ACS between August 2007 and August 2010 were recorded using the Acute Predict database. Patients (pts) were categorised low (<3%), intermediate (3–8%), and high risk (>8%) based on the GRACE admission-to-six month mortality score. Results: Of 3666 pts, 34%, 38% and 28% were low, intermediate and high risk, respectively. Europeans were more likely to be high risk than Maori, Pacific or Indians (32% vs 16%, 20%, and 20%, respectively). High risk pts were older, more likely to be women and to present with heart failure, impaired LV systolic function and severe coronary artery disease. However, high risk pts were less likely than low risk to receive coronary angiography (58 vs 83%, p < .001) and revascularisation (43 vs 58%, p < .001). The median time to angiogram was three days for all three risk groups, with no difference according to risk category at any centre. Conclusion: ACS pts categorised at high risk by GRACE score were least likely to receive coronary angiography and revascularisation, and were not prioritised ahead of lower risk pts. Routine use of a risk score to guide timing of coronary angiography post-ACS should be considered. http://dx.doi.org/10.1016/j.hlc.2012.05.096 87 Does Age Change the Effect of Depressive Symptoms on Mortality in Patients with Coronary Heart Disease? P. Miller ∗ , K. Dracup University of California, San Francisco, United States Background: Depression in patients with coronary heart disease (CHD) is common and associated with mortality. Given limited research, we aimed to determine whether depressive symptoms predict two-year all-cause mortality (ACM) among younger and older age groups diagnosed with CHD. Methods: In a secondary analysis of a longitudinal randomised controlled trial, 3454 CHD patients living in Australia, New Zealand and the United States were assessed at baseline for depressive symptoms using the Multiple Adjective Affect Checklist-D and followed for 2-years. Patients were categorised by age in decades.