EBQ:ADAPT Trial 2-Hour Troponin Rule Out - Revision history

Danbot: Added Study Design section

2026-03-21T22:36:29Z

Added Study Design section

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	*Although using the same patients, the ADAPT trial was approved at the initiation of the [[EBQ:ASPECT Trial\|ASPECT Trial]].		*Although using the same patients, the ADAPT trial was approved at the initiation of the [[EBQ:ASPECT Trial\|ASPECT Trial]].
	*Patients were enrolled consecutively between November 2007 and February 2011		*Patients were enrolled consecutively between November 2007 and February 2011

			==Study Design==
			*Prospective, multicenter observational study
			*14 emergency departments across 9 countries (Asia-Pacific region)
			*N = 1,975 patients
			*Primary Outcome: 30-day major adverse cardiac events (MACE)
			*Accelerated diagnostic protocol (ADP) combining TIMI score, ECG, and 0/2-hour troponin

	==Population==		==Population==

Orinoco w: /* Major Points */

2017-03-23T05:11:30Z

Major Points

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	==Major Points==		==Major Points==
	*The ADP relies on a combination of 2 negative troponins, a [[ACS_-_Risk_Stratification#TIMI_Risk_Stratification_Score\|TIMI]] score < 0 and no ischemic changes on ECG.		*The ADP relies on a combination of 2 negative troponins, a [[ACS_-_Risk_Stratification#TIMI_Risk_Stratification_Score\|TIMI]] score = 0 and no ischemic changes on ECG.
	*The ADP successfully classifies patients as low risk and has a sensitivity of 99.7 for identifying patients who will have Major Adverse Cardiac Events (MACE)		*The ADP successfully classifies patients as low risk and has a sensitivity of 99.7 for identifying patients who will have Major Adverse Cardiac Events (MACE)
	*Patients who are not low risk according to the ADP should continue to be managed with existing clinical care that involves extended observation or admission.		*Patients who are not low risk according to the ADP should continue to be managed with existing clinical care that involves extended observation or admission.
	*Patients with a negative troponin at 0 hours and 2 hrs, a TIMI<0 and no ischemic ECG changes can be discharged with close cardiac followup.		*Patients with a negative troponin at 0 hours and 2 hrs, a TIMI=0 and no ischemic ECG changes can be discharged with close cardiac followup.

	'''All parameters had to be negative for the ADP to be considered negative and for the patient to be identified as low-risk		'''All parameters had to be negative for the ADP to be considered negative and for the patient to be identified as low-risk
	#cTnI level at 0 and 2 h below institutional cutoff for an elevated troponin concentration		#cTnI level at 0 and 2 h below institutional cutoff for an elevated troponin concentration
	#No new ischemic changes on the initial ECG 3. TIMI score < 0'''		#No new ischemic changes on the initial ECG 3. TIMI score = 0'''

	{{TIMI Score}}		{{TIMI Score}}

Orinoco w: /* Conclusion */

2017-03-23T05:10:35Z

Conclusion

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	==Conclusion==		==Conclusion==
	'''An accelerated diagnostic protocol of 2 negative troponins, a TIMI score < 0 and no ischemic changes on ECG. can successfully identify low risk chest pain patients for discharge from the emergency department and decrease observational stay.'''		'''An accelerated diagnostic protocol of 2 negative troponins, a TIMI score = 0 and no ischemic changes on ECG. can successfully identify low risk chest pain patients for discharge from the emergency department and decrease observational stay.'''

	==Major Points==		==Major Points==

Ostermayer: Text replacement - "Category:Cards" to "Category:Cardiology"

2016-03-22T13:53:34Z

Text replacement - "Category:Cards" to "Category:Cardiology"

← Revisión anterior		Revisión del 13:53 22 mar 2016
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	<references/>		<references/>

	[[Category:EBQ]][[Category:~~Cards~~]]		[[Category:EBQ]][[Category:Cardiology]]

Ostermayer: /* Baseline Characteristics */

2014-07-04T10:24:10Z

Baseline Characteristics

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	*Staff considered recruitment to be inappropriate (e.g., receiving palliative treatment), transfer from another hospital, pregnancy, previous enrollment, or inability to be contacted after discharge.		*Staff considered recruitment to be inappropriate (e.g., receiving palliative treatment), transfer from another hospital, pregnancy, previous enrollment, or inability to be contacted after discharge.
	===Baseline Characteristics===		===Baseline Characteristics===
			*Age: 60.4
			*Male: 60.0%
			*White Race: 90%
			*Risk Factors
			**HTN: 52.1%
			**DM: 14.4
			**Dyslipidemia: 51

	==Interventions==		==Interventions==

Ostermayer: /* Criticisms and Further Discussion */

2014-05-28T22:49:00Z

Criticisms and Further Discussion

← Revisión anterior		Revisión del 22:49 28 may 2014
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	*74% of patients had a followup provocative study so this protocol should not be initiated if proper outpatient followup cannot be imitated<ref name="commentary"></ref>		*74% of patients had a followup provocative study so this protocol should not be initiated if proper outpatient followup cannot be imitated<ref name="commentary"></ref>

	*With a high combined sensitivity it offers promise for ruling out MACE but the low specificity it may actually result if too stringent a criteria with unnecessary chest pain admissions.		*With a high combined sensitivity it offers promise for ruling out MACE but the low specificity may actually result in too stringent a criteria with unnecessary chest pain admissions.

	==Funding==		==Funding==

Ostermayer: /* Criticisms and Further Discussion */

2014-05-28T22:48:30Z

Criticisms and Further Discussion

← Revisión anterior		Revisión del 22:48 28 may 2014
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	*The TIMI score has questionable application to an acute ED population since it was developed for inpatients<ref name="commentary">Hess, Erik et al. Evaluation of Patients With Possible Cardiac Chest Pain - A Way Out of the Jungle. J Am Coll Cardiol. 2012;59(23):2099-2100. doi:10.1016/j.jacc.2012.03.021 [http://content.onlinejacc.org/data/Journals/JAC/24307/03021.pdf PDF]</ref>		*The TIMI score has questionable application to an acute ED population since it was developed for inpatients<ref name="commentary">Hess, Erik et al. Evaluation of Patients With Possible Cardiac Chest Pain - A Way Out of the Jungle. J Am Coll Cardiol. 2012;59(23):2099-2100. doi:10.1016/j.jacc.2012.03.021 [http://content.onlinejacc.org/data/Journals/JAC/24307/03021.pdf PDF]</ref>

	*74% of patients had a followup provocative study so this protocol should not be initiated if proper outpatient followup cannot be ~~initated~~<ref name="commentary"></ref>		*74% of patients had a followup provocative study so this protocol should not be initiated if proper outpatient followup cannot be imitated<ref name="commentary"></ref>

			*With a high combined sensitivity it offers promise for ruling out MACE but the low specificity it may actually result if too stringent a criteria with unnecessary chest pain admissions.

	==Funding==		==Funding==

Ostermayer at 22:31, 28 May 2014

2014-05-28T22:31:55Z

← Revisión anterior		Revisión del 22:31 28 may 2014
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	\| fulltexturl= http://content.onlinejacc.org/article.aspx?articleid=1216447		\| fulltexturl= http://content.onlinejacc.org/article.aspx?articleid=1216447
	\| pdfurl= http://content.onlinejacc.org/data/Journals/JAC/24307/02035.pdf		\| pdfurl= http://content.onlinejacc.org/data/Journals/JAC/24307/02035.pdf
	\| status = ~~Under Review~~		\| status =Complete
	}}		}}

Ostermayer: /* Criticisms and Further Discussion */

2014-05-28T22:31:41Z

Criticisms and Further Discussion

← Revisión anterior		Revisión del 22:31 28 may 2014
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	*The study uses the used Troponin I (cTnI) not the high sensitivity version (hs-cTnI).<ref>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3627711/</ref> If using this troponin the study can directly apply to certain EDs. However if using the high sensitivity version then more positives are likely and the the patients with negative rapid diagnostics protocols will be less and admission rates may be higher		*The study uses the used Troponin I (cTnI) not the high sensitivity version (hs-cTnI).<ref>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3627711/</ref> If using this troponin the study can directly apply to certain EDs. However if using the high sensitivity version then more positives are likely and the the patients with negative rapid diagnostics protocols will be less and admission rates may be higher

	*The TIMI score has ~~very little~~ application to an acute ED population since it was developed for inpatients<ref>Hess, Erik et al. Evaluation of Patients With Possible Cardiac Chest Pain - A Way Out of the Jungle. J Am Coll Cardiol. 2012;59(23):2099-2100. doi:10.1016/j.jacc.2012.03.021 [http://content.onlinejacc.org/data/Journals/JAC/24307/03021.pdf PDF]</ref>		*The TIMI score has questionable application to an acute ED population since it was developed for inpatients<ref name="commentary">Hess, Erik et al. Evaluation of Patients With Possible Cardiac Chest Pain - A Way Out of the Jungle. J Am Coll Cardiol. 2012;59(23):2099-2100. doi:10.1016/j.jacc.2012.03.021 [http://content.onlinejacc.org/data/Journals/JAC/24307/03021.pdf PDF]</ref>

			*74% of patients had a followup provocative study so this protocol should not be initiated if proper outpatient followup cannot be initated<ref name="commentary"></ref>

	==Funding==		==Funding==

Ostermayer: /* Criticisms and Further Discussion */

2014-05-28T21:16:18Z

Criticisms and Further Discussion

← Revisión anterior		Revisión del 21:16 28 may 2014
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	*The pretest probability for MACE was 15.3% which may differ for many readers depending on their patient population. Also this protocol has not been validated at any outside institution.		*The pretest probability for MACE was 15.3% which may differ for many readers depending on their patient population. Also this protocol has not been validated at any outside institution.

			*The study uses the used Troponin I (cTnI) not the high sensitivity version (hs-cTnI).<ref>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3627711/</ref> If using this troponin the study can directly apply to certain EDs. However if using the high sensitivity version then more positives are likely and the the patients with negative rapid diagnostics protocols will be less and admission rates may be higher

			*The TIMI score has very little application to an acute ED population since it was developed for inpatients<ref>Hess, Erik et al. Evaluation of Patients With Possible Cardiac Chest Pain - A Way Out of the Jungle. J Am Coll Cardiol. 2012;59(23):2099-2100. doi:10.1016/j.jacc.2012.03.021 [http://content.onlinejacc.org/data/Journals/JAC/24307/03021.pdf PDF]</ref>

	==Funding==		==Funding==