2002 ACC/AHA guideline versus clinician judgment as diagnostic tests for chest pain.

PURPOSE: Hospital admissions for chest pain are frequent and costly. The use of objective criteria to determine the need for hospitalization may save money. Here we compare the 2002 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of patients with unstable angina and nonST-segment elevation myocardial infarction to clinical judgment as diagnostic tests to predict which patients with chest pain will develop positive cardiac troponin-I.

METHODS

Researchers conducted a retrospective chart review of patients admitted to a military community hospital for chest pain over a 2-year period. The study determined sensitivity and specificity for both the ACC/AHA guidelines and consensus of clinical judgment to predict which subjects would develop positive cardiac troponin-I.

RESULTS

Positive cardiac troponin-I was very low (7 of 386). Both the ACC/AHA guidelines and clinical judgment had sensitivities of 100% (95% CI, 65-100) to predict positive cardiac troponin-I. The ACC/AHA guideline was 13% specific (95% CI, 12-13), with clinical judgment at 48% (95% CI, 47-48). Classification as low risk had a high negative predictive value (ACC/AHA guideline, 1.00 [95% CI, 0.95-1.00]; clinical judgment, 1.00 [95% CI, 0.99-1.00]).

CONCLUSION

Patients categorized as low risk by either method could probably be discharged from the emergency department without developing positive troponin-I.